^^K 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 

GIFT  OF 


DR.  AND  MRS.  ELMER  BELT 


NOTES  ON  NURSING: 


WHAT  IT  IS,  AND  WHAT  IT  IS  NOT. 


BY 


FLORE^^CE  ^^IGIITIIGALE, 


NEW  YORK: 
D.  APPLETOIT  AND   COMPANY, 

1,  3,  AND  5  BOND  BTEEET. 

1883. 


A  ' 


PREFACE 


The  following  notes  are  by  no  means  intended  as 
a  rule  of  thought  by  which  nurses  can  teach  them- 
selves to  nurse,  still  less  as  a  manual  to  teach 
nurses  to  nurse.  They  are  meant  simply  to  give 
hints  for  thought  to  women  who  have  personal 
charge  of  the  health  of  others.  Every  woman,  or 
at  least  almost  every  woman,  in  England  has,  at 
one  time  or  another  of  her  life,  charge  of  the  per- 
sonal health  of  somebody,  whether  child  or  invalid, 
— in  other  words,  every  woman  is  a  nurse.  Every 
day  sanitary  knowledge,  or  the  knowledge  of  nurs- 
ing, or  in  other  words,  of  how  to  put  the  constitu- 
tion in  such  a  state  as  that  it  will  have  no  disease, 
or  that  it  can  recover  from  disease,  takes  a  higher 
place.  It  is  recognized  as  the  knowledge  which 
every  one  ought  to  have — distinct  from  medical 
knowledge,  which  only  a  profession  can  have. 


4  PREFACE. 

If,  then,  every  woman  must  at  some  time  or 
other  of  her  life,  becom-e  a  nurse,  i.e.,  have  charge 
of  somebody's  health,  how  immense  and  how  valu- 
able would  be  the  produce  of  her  united  experi- 
ence if  every  woman  would  think  how  to  nurse. 

I  do  not  pretend  to  teach  her  how,  I  ask  her  to 
teach  herself,  and  for  this  purpose  I  venture  to  give 
her  some  hints. 


TABLE    OF    CONTENTS 


PAGE 

Ventilation  and  Waeming 12 

Health  of  Houses 24 

Petty  Management 35 

Noise ^ 

Yaeiett ^8 

Taking  Food 63 

What  Food? 69 

Bed  and  Bedding    ..*....  T9 

Light ^"^ 

Cleanliness  of  Rooms  and  Walls          ...  87 

Personal  Cleanliness 93 

Chattering  Hopes  and  Advices      .        .        .        .  95 

Observation  of  the  Sick 105 

Conclusion 12^ 

Appendix 137 


NOTES    ON    NURSING: 

WHAT    IT    IS,    AND    WHAT    IT    IS    NOT 


Shall  we  begin  by  taking  it  as  a  general  principle—  JJ^p'^Svo 
that  all  disease,  at  some  period  or  other  of  its  course,  is  Process. 
more  or  less  a  reparative  process,  not  necessarily  accom- 
panied with  suffering :  an  effort  of  nature  to  remedy  a 
process  of  poisoning  or  of  decay,  which  has  taken  place 
weeks,  months,  sometimes  years  beforehand,  unnoticed, 
the  termination  of  the  disease  being  then,  while  the  an- 
tecedent process  was  going  on,  determined  ? 

If  we  accept  this  as  a  general  principle,  we  shall  be 
immediately  met  with  anecdotes  and  instances  to  prove 
the  contrary.  Just  so  if  we  were  to  take,  as  a  principle 
— all  the  climates  of  the  earth  are  meant  to  be  made 
habitable  for  man,  by  the  efforts  of  man — the  objection 
would  be  immediately  raised, — Will  the  top  of  Mount 
Blanc  ever  be  made  habitable  ?  Our  answer  would  be, 
it  will  be  many  thousands  of  years  before  we  have  reached 
the  bottom  of  Mount  Blanc  in  making  the  earth  healthy. 
Wait  till  we  have  reached  the  bottom  before  we  discuss 
the  top. 


8 


NOTES   ON   NUESING. 


Of  the  suf- 
ferings of 
disease,  dis- 
ease not  al- 
ways the 
cause. 


"What  nurs- 
ing ought  to 
do. 


Nursing  the 
ticlc  little 
understood. 


In  watcLing  diseases,  both  in  private  houses  and  in 
public  hospitals,  the  thing  which  strikes  the  experienced 
observer  most  forcibly  is  this,  that  the  symptoms  or  the 
sufferings  generally  considered  to  be  inevitable  and  inci- 
dent to  the  disease  are  very  often  not  symptoms  of  the 
disease  at  all,  but  of  something  quite  different — of  the 
want  of  fresh  air,  or  of  light,  or  of  warmth,  or  of  quiet,  or 
of  cleanliness,  or  of  punctuality  and  care  in  the  admin- 
istration of  diet,  of  each  or  of  all  of  these.  And  this 
quite  as  much  in  private  as  in  hospital  nursing. 

The  reparative  process  which  Nature  has  instituted 
and  which  we  call  disease,  has  been  hindered  by  some 
want  of  knowledge  or  attention,  in  one  or  in  all  of  these 
things,  and  pain,  suffering,  or  interruption  of  the  whole 
process  sets  in. 

If  a  patient  is  cold,  if  a  patient  is  feverish,  if  a  pa- 
tient is  faint,  if  he  is  sick  after  taking  food,  if  he  has  a 
bed-sore,  it  is  generally  the  fault  not  of  the  disease,  but 
of  the  nursing. 

I  use  the  word  nursing  for  want  of  a  better.  It  has 
been  limited  to  signify  Httle  more  than  the  administra- 
tion of  medicines  and  the  application  of  poultices.  It 
ought  to  signify  the  proper  use  of  fresh  air,  light,  warmth, 
cleanliness,  quiet,  and  the  proper  selection  and  adminis- 
tration of  diet — all  at  the  least  expense  of  vital  power  to 
the  patient. 

It  has  been  said  and  written  scores  of  times,  that 
every  woman  makes  a  good  nurse.  I  believe,  on  the 
contrary,  that  the  very  elements  of  nursing  are  all  but 
unknown. 

By  this  I  do  not  mean  that  the  nurse  is  always  to 
blame.  Bad  sanitary,  bad  architectural,  and  bad  admin- 
istrative arrangements  often  make  it  impossible  to  nurse. 


NOTES    ON   NUESESTG.  9 

But  the  art  of  nursing  ought  to  include  such  arrange- 
ments as  alone  make  what  I  understand  by  nursing,  pos- 
sible. 

The  art  of  nursing,  as  now  practised,  seems  to  be  ex- 
pressly constituted  to  unmake  what  God  had  made  disease 
to  be,  viz.,  a  reparative  process. 

To  recur  to  the  first  obiection.     If  we  are  asked,  Is  Narsing 

**  '         ought  to  as- 

Buch  or  such  a  disease  a  reparative  process  ?     Can  such  ^i^t  the  re- 

■^  ^  parativepro- 

an  illness  be  unaccompanied  with  suffering  ?  Will  any  cess. 
care  prevent  such  a  patient  from  suffering  this  or  that  ? 
— I  humbly  say,  I  do  not  know.  But  when  you  have 
done  away  with  all  that  pain  and  suffering,  which  in  pa- 
tients are  the  symptoms  not  of  their  disease,  but  of  the  ab- 
sence of  one  or  all  of  the  above-mentioned  essentials  to 
the  success  of  Nature's  reparative  processes,  we  shall  then 
know  what  are  the  symptoms  of  and  the  sufferings  insep- 
arable from  the  disease. 

Another  and  the  commonest  exclamation  which  will 
be  instantly  made  is — Would  you  do  nothing,  then,  in 
cholera,  fever,  &c.  ? — so  deep-rooted  and  universal  is  the 
conviction  that  to  give  medicine  is  to  be  doing  some- 
thing, or  rather  everything  ;  to  give  air,  warmth,  clean- 
liness, &c.,  is  to  do  nothing.  The  reply  is,  that  in  these 
and  many  other  similar  diseases  the  exact  value  of  par- 
ticular remedies  and  modes  of  treatment  is  by  no  means 
ascertained,  while  there  is  universal  experience  as  to  the 
extreme  importance  of  careful  nursing  in  determining  the 
issue  of  the  disease. 

II.  The  very  elements  of  what  constitutes  good  nurs-  Nursing  the 
ing  are  as  little  understood  for  the  well  as  for  the  sick. 
The  same  laws  of  health  or  of  nursing,  for  they  are  in  re- 
ality the  same,  obtain  among  the  well  as  among  the  sick. 
The  breaking  of  them  produces  only  a  less  violent  conse- 
1* 


10  NOTES   ON  NURSING. 

quence  among  the  former  than  among  the  latter, — and 
this  sometimes,  not  always. 

It  is  constantly  objected, — "  But  how  can  I  obtain 
this  medical  knowledge  ?     I  am  not  a  doctor.     I  must 
leave  this  to  doctors." 
d^"if  T'  ^^'  ^^^^^^s  ^^  families !     You  who  say  this,  do  you 

know  that  one  in  every  seven  infants  in  this  civilized  land 
of  England  perishes  before  it  is  one  year  old  ?  That,  in 
London,  two  in  every  five  die  before  they  are  five  years 
old?  And,  in  the  other  great  cities  of  England,  nearly 
one  out  of  two  "?  *     "  The  life  duration  of  tender  babies  '* 


Curious  *  Upon  this  fact  the  most  wonderful  deductions  have  been 

from  an  ex-  Strung.  For  a  long  time  an  announcement  something  like  the  fol- 
death  rate  lowing  has  been  going  the  round  of  the  papers : — "  More  than 
25,000  children  die  every  year  in  London  under  10  years  of  age  ; 
therefore  we  want  a  Children's  Hospital."  This  spring  there  was 
a  prospectus  issued,  and  divers  other  means  taken  to  this  effect : — 
"  There  is  a  great  want  of  sanitary  knowledge  in  women ;  therefore 
we  want  a  "Women's  Hospital."  Now,  both  the  above  facts  are 
too  sadly  true.  But  what  is  the  deduction?  The  causes  of  the 
enormous  child  mortality  are  perfectly  well  known ;  they  are 
chiefly  want  of  cleanliness,  want  of  ventilation,  want  of  white- 
washing ;  in  one  word,  defective  household  hygiene.  The  reme- 
dies are  just  as  well  known  ;  and  among  them  is  certainly  not  the 
establishment  of  a  Child's  Hospital.  This  may  be  a  want ;  just  as 
there  may  be  a  want  of  hospital  room  for  adults.  But  the  Registrar- 
General  would  certainly  never  think  of  giving  us  as  a  cause  for  the 
high  rate  of  child  mortality  in  (say)  Liverpool  that  there  was  not 
sufficient  hospital  room  for  children  ;  nor  would  he  urge  upon  us, 
as  a  remedy,  to  found  an  hospital  for  them. 

Again,  women,  and  the  best  women,  are  wofully  deficient  in 
sanitary  knowledge  ;  although  it  is  to  women  that  we  must  look, 
first  and  last,  for  its  application,  as  far  as  household  hygiene  is 
concerned.  But  who  would  ever  think  of  citing  the  institution  of 
a  "Women's  Hospital  as  the  way  to  cure  this  want  ? 

"We  have  it,  indeed,  upon  very  high  authority  that  there  is 


NOTES   ON   NURSING.  11 

(as  some  Saturn,  turned  analytical  chemist,  says)  "  is  the 
most  delicate  test "  of  sanitary  conditions.  Is  aU  this 
premature  suffering  and  death  necessary  ?  Or  did  Na- 
ture intend  mothers  to  be  always  accompanied  by  doc- 
tors ?  Or  is  it  better  to  learn  the  piano-forte  than  to 
learn  the  laws  which  subserve  the  preservation  of  off- 
spring ? 

Macaulay  somewhere  says,  that  it  is  extraordinary 
that,  whereas  the  laws  of  the  motions  of  the  heavenly 
bodies,  far  removed  as  they  are  from  us,  are  perfectly  well 
understood,  the  laws  of  the  human  mind,  which  are  under 
our  observation  all  day  and  every  day,  are  no  better  un- 
derstood than  they  were  two  thousand  years  ago. 

But  how  much  more  extraordinary  is  it  that,  whereas 
what  we  might  call  the  coxcombries  of  education — e.  g.^ 
the  elements  of  astronomy — are  now  taught  to  every 
school-girl,  neither  mothers  of  families  of  any  class,  nor 
school-mistresses  of  any  class,  nor  nurses  of  children,  nor 
nurses  of  hospitals,  are  taught  anything  about  those  laws 
which  God  has  assigned  to  the  relations  of  our  bodies 
with  the  world  in  which  He  has  put  them.  In  other 
words,  the  laws  which  make  these  bodies,  into  which  He 
has  put  our  minds,  healthy  or  unhealthy  organs  of  those 
minds,  are  all  but  unlearnt.  Not  but  that  these  laws — 
the  laws  of  life — are  in  a  certain  measure  understood,  but 
not  even  mothers  think  it  worth  their  while  to  study 
them — to  study  how  to  give  their  children  healthy  exist- 
ences. They  call  it  medical  or  physiological  knowledge, 
fit  only  for  doctors. 

some  fear  lest  hospitals,  as  they  have  been  hitherto^  may  not  have 
generally  increased,  rather  than  diminished,  the  rate  of  mortality 
—especially  of  child  mortality. 


12  NOTES    ON   NUESING. 

Another  objection. 

"We  are  constantly  told, — "But  the  circumstances 
which  govern  our  children's  healths  are  beyond  our  con- 
trol. What  can  we  do  with  winds  ?  There  is  the  east 
wind.  Most  people  can  tell  before  they  get  up  in  the 
morning  whether  the  wind  is  in  the  east." 

To  this  one  can  answer  with  more  certainty  than  to 
the  former  objections.  Who  is  it  who  knows  when  the 
wind  is  in  the  east  1  Not  the  Highland  drover,  certain- 
ly, exposed  to  the  east  wind,  but  the  young  lady  who  is 
worn  out  with  the  want  of  exposure  to  fresh  air,  to  sun- 
light, &c.  Put  the  latter  under  as  good  sanitary  cir- 
cumstances as  the  former,  and  she  too  will  not  know 
when  the  wind  is  in  the  east. 


I.   VENTILATION  AND   WARMING. 

First  rule  <\         The  very  first  canon  of  nursing,  the  first  and  the  last 
keep  the  air  thing  upon  which  a  nurse's  attention  must  be  fixed,  the 
pure^as^he    ^^^t  essential  to  a  patient,  without  which  all  the  rest  you 
can  do  for  him  is  as  nothing,  with  which  I  had  almost 
said  you  may  leave  all  the  rest  alone,  is  this :  To  keep 

THE  AIR  HE  BREATHES  AS  PURE  AS  THE  EXTERNAL  AIR, 

WITHOUT  CHILLING  HIM.  Yet  what  is  SO  little  attended 
to  ?  Even  where  it  is  thought  of  at  all,  the  most  extra- 
ordinary misconceptions  reign  about  it.  Even  in  admit- 
ting air  into  the  patient's  room  or  ward,  few  people  ever 
think,  where  that  air  comes  from.  It  may  come  from  a 
corridor  into  which  other  wards  are  ventilated,  from  a 
hall,  always  unaired,  always  full  of  the  fumes  of  gas,  din- 
ner, of  various  kinds  of  mustiness  ;  from  an  underground 
kitchen,  sink,  washhouse,  water-closet,  or  even,  as  I  my- 
self have  had  sorrowful  experience,   from  open   sewers 


•within  as 
pure  as  tl 
air  without. 


VENTILATION   AND   WARMING.  13 

loaded  with  filth ;  and  with  this  the  patient's  room  or 
ward  is  aired,  as  it  is  called — poisoned,  it  should  rather 
be  said.  Always  air  from  the  air  without,  and  that,  too, 
through  those  windows,  through  which  the  air  comes 
freshest.  From  a  closed  court,  especially  if  the  wind  do 
not  blow  that  way,  air  may  come  as  stagnant  as  any 
from  a  hall  or  corridor. 

Again,  a  thing  I  have  often  seen  both  in  private  houses 
and  institutions.  A  room  remains  uninhabited  ;  the  fire- 
place is  carefully  fastened  up  with  a  board ;  the  windows 
are  ne\^er  opened ;  probably  the  shutters  are  kept  always 
shut ;  perhaps  some  kind  of  stores  are  kept  in  the  room ; 
no  breath  of  fresh  air  can  by  possibility  enter  into  that 
room,  nor  any  ray  of  sun.  The  air  is  as  stagnant,  musty, 
and  corrupt  as  it  can  by  possibility  be  made.  It  is  quite 
ripe  to  breed  small-pox,  scarlet-fever,  diphtheria,  or  any^ 
thing  else  you  please.* 

Yet  the  nursery,  ward,  or  sick  room  adjoining  will 
positively  be  aired  (?)  by  having  the  door  opened  into 
that  room.  Or  children  will  be  put  into  that  room, 
without  previous  preparation,  to  sleep. 

A  short  time  ago  a  man  walked  into  a  back-kitchen 
in  Queen  square,  and  cut  the  throat  of  a  poor  consump- 
tive creature,  sitting  by  the  fire.  The  murderer  did  not 
deny  the  act,  but  simply  said,  "  It's  all  right."  Of  course 
he  was  mad. 

*  The  common  idea  as  to  uninhabited  rooms  is,  that  they  may  Why  are  un 
safely  be  left  with  doors,  windows,  shutters,  and  chimney-board,  rooms  shut 
all  closed — hermetically  sealed  if  possible — to  keep  out  the  dust,  "P  ^ 
it  is  said  ;  and  that  no  harm  will  happen  if  the  room  is  but  opened 
a  short  hour  before  the  inmates  are  put  in.     I  have  often  been 
asked  the  question  for  uninhabited  rooms. — But  when  ought  the 
windows  to  bo  opened  ?     The  answer  is — When  ought  they  to  be 
shut? 


chill. 


14  NOTES   ON   NURSING. 

But  in  our  case,  the  extraordinary  thing  is  that  the 
victim  says,  "  It's  all  right,"  and  that  we  are  not  mad. 
Yet,  although  we  "  nose  "  the  murderers,  in  the  musty  un- 
aired  unsunned  room,  the  scarlet  fever  which  is  behind  the 
door,  or  the  fever  and  hospital  gangrene  which  are  stalk- 
ing among  the  crowded  beds  of  a  hospital  ward,  we  say, 
"  It's  all  right." 
Without  With  a  proper  supply  of  windows,  and  a  proper  sup- 

ply of  fuel  in  open  fire  places,  fresh  air  is  comparatively 
easy  to  secure  when  your  patient  or  patients  are  in  bed. 
Never  be  afraid  of  open  windows  then.  People  don't 
catch  cold  in  bed.  This  is  a  popular  fallacy.  With 
proper  bed-clothes  and  hot  bottles,  if  necessary,  you  can 
always  keep  a  patient  warm  in  bed,  and  well  ventilate 
him  at  the  same  time. 

But  a  careless  nurse,  be  her  rank  and  education  what 
it  may,  will  stop  up  every  cranny  and  keep  a  hot-house 
heat  when  her  patient  is  in  bed, — and,  if  he  is  able  to 
get  up,  leave  him  comparatively  unprotected.  The  time 
when  people  take  cold  (and  there  are  many  ways  of 
taking  cold,  besides  a  cold  in  the  nose,)  is  when  they 
first  get  up  after  the  two-fold  exhaustion  of  dressing  and 
of  having  had  the  skin  relaxed  by  many  hours,  perhaps 
days,  in  bed,  and  thereby  rendered  more  incapable  of 
re-action.  Then  the  same  temperature  which  refreshes 
the  patient  in  bed  may  destroy  the  patient  just  risen. 
And  common  sense  will  point  out,  that,  while  purity  of 
air  is  essential,  a  temperature  must  be  secured  which 
shall  not  chill  the  patient.  Otherwise  the  best  that  can 
be  expected  will  be  a  feverish  re-action. 

To  have  the  air  within  as  pure  as  the  air  without,  it 
is  not  necessary,  as  often  appears  to  be  thought,  to  make 
it  as  cold. 


VENTILATION   AND    WARMING.  15 

In  the  afternoon  again,  without  care,  the  patient 
whose  vital  powers  have  then  risen  often  finds  the  room 
as  close  and  oppressive  as  he  found  it  cold  in  the  morn- 
ing. Yet  the  nurse  will  be  terrified,  if  a  window  is 
opened.* 

I  know  an  intellis^ent  humane  house  surjjeon  who  Openwia- 
makes  a  practice  of  keeping  the  ward  windows  open. 
The  physicians  and  surgeons  invariably  close  them  while 
going  their  rounds ;  and  the  house  surgeon  very  properly 
as  invariably  opens  them  whenever  the  doctors  have 
turned  their  backs. 

In  a  little  book  on  nursing,  published  a  short  time 
ago,  we  are  told,  that,  "  with  proper  care  it  is  very  sel- 
dom that  the  windows  cannot  be  opened  for  a  few  min- 
utes twice  in  the  day  to  admit  fresh  air  from  without." 
I  should  think  not ;  nor  twice  in  the  hour  either.  It 
only  shows  how  little  the  subject  has  been  considered. 

Of  all  methods  of  keeping  patients  warm  the  very  What  kim 
worst  certainly  is  to  depend  for  heat  on  the  breath  and  desirable, 
bodies  of  the  sick.  I  have  known  a  medical  ofiicer  keep 
his  ward  windows  hermetically  closed.  Thus  exposing 
the  sick  to  all  the  dangers  of  an  infected  atmosphere, 
because  he  was  afraid  that,  by  admitting  fresh  air,  the 
temperature  of  the  ward  would  be  too  much  lowered. 
This  is  a  destructive  fallacy. 

To  attempt  to  keep  a  ward  warm  at  the  expense  of 

*  It  is  very  desirable  that  the  windows  in  a  sick  room  should 
be  such  that  the  patient  ahall,  if  he  can  movfe  about,  be  able  to 
open  and  shut  them  easily  himself.  In  fact,  the  sick  room  is  very 
seldom  kept  aired  if  this  is  not  the  case — so  very  few  people  have 
any  perception  of  what  is  a  healthy  atmosphere  for  the  sick.  The 
sick  man  often  says,  "  This  room  where  I  spend  22  hours  out  of 
the  24,  is  fresher  than  the  other  where  I  only  spend  2.  Because 
here  I  can  manage  the  windows  myself."     And  it  is  true. 


16  NOTES    ON   NURSING. 

making  the  sick  repeatedly  breathe  their  own  hot,  humid, 
putrescing  atmosphere  is  a  certain  way  to  delay  recovery 
or  to  destroy  life. 
Bedrooms  J)q  you  ever  2^0  into  the  bed-rooms  of  any  persons  of 

almost  um-  J  &  ^    i 

-versaiiyfoui.  any  class,  whether  they  contain  one,  two,  or  twenty 
people,  whether  they  hold  sick  or  well,  at  night,  or  be- 
fore the  windows  are  opened  in  the  morning,  and  ever 
find  the  air  anything  but  un wholesomely  close  and  foul? 
And  why  should  it  be  so  ?  And  of  how  much  importance 
it  is  that  it  should  not  be  so?  During  sleep,  the  human 
body,  even  when  in  health,  is  far  more  injured  by  the 
influence  of  foul  air  than  when  awake.  Why  can't  you 
keep  the  air  all  night,  then,  as  pure  as  the  air  without  in 
the  rooms  you  sleep  in  ?  But  for  this,  you  must  have 
sufficient  outlet  for  the  impure  air  you  make  yourselves 
to  go  out ;  sufficient  inlet  for  the  pure  air  from  without 
to  come  in.  You  must  have  open  chimneys,  open  win- 
dows, or  ventilators  ;  no  close  curtains  round  your  beds  ; 
no  shutters  or  curtains  to  your  windows,  none  of  the 
contrivances  by  which  you  undermine  your  own  health 
or  destroy  the  chances  of  recovery  of  your  sick.* 

An  air-test  *  Dr.  Angus  Smith's  air  test,  if  it  could  be  made  of  simpler 

conse-^    ^       application,  would  be  invaluable  to  use  in  every  sleeping  and  sick 
qucnce.  room.     Just  as  without  the  use  of  a  thermometer  no  nurse  should 

ever  put  a  patient  into  a  bath,  so  should  no  nurse,  or  mother,  or 
superintendent,  be  without  the  air  test  in  any  ward,  nursery,  or 
sleeping-room.  If  the  main  function  of  a  nurse  is  to  maintain 
the  air  within  the  room  as  fresh  as  the  air  without,  without  lowering 
the  temperature,  then  she  should  always  be  provided  with  a  ther- 
mometer which  indicates  the  temperature,  with  an  air  test  which 
indicates  the  organic  matter  of  the  air.  But  to  be  used,  the  latter 
must  be  made  as  simple  a  little  instrument  as  the  former,  and  both 
should  be  self-registering.  The  senses  of  nurses  and  mothers  be- 
come so  dulled  to  foul  air,  that  they  are  perfectly  unconscious  of 
what  an  atmosphere  they  have  let  their  children,  patients,  or 


VENTILATION   AND    WARMING.  17 


A  careful  nurse  will  keep  a  constant  watch  over  her  vrhen 
sick,  especially  weak,  protracted,  and  collapsed  cases,  to  musTbe 
guard  against  the  eflfects  of  the  loss  of  vital  heat  by  the  Suy  looked 
patient  himself  In  certain  diseased  states  much  less 
heat  is  produced  than  in  health ;  and  there  is  a  constant 
tendency  to  the  decline  and  ultimate  extinction  of  the 
vital  powers  by  the  call  made  upon  them  to  sustain  the 
heat  of  the  body.  Cases  where  this  occurs  should  be 
watched  with  the  greatest  care  from  hour  to  hour,  I  had 
almost  said  from  minute  to  minute.  The  feet  and  legs 
should  be  examined  by  the  hand  from  time  to  time,  and 
whenever  a  tendency  to  chilling  is  discovered,  hot  bottles, 
hot  bricks,  or  warm  flannels,  with  some  warm  drink, 
should  be  made  use  of  until  the  temperature  is  restored. 
The  fire  should  be,  if  necessary,  replenished.  Patients 
are  frequently  lost  in  the  latter  stages  of  disease  from 
want  of  attention  to  such  simple  precautions.  The  nurse 
may  be  trusting  to  the  patient's  diet,  or  to  his  medicine, 

charges,  sleep  in.  But  if  the  tell-tale  air  test  were  to  exhibit  in 
the  morning,  both  to  nurses  and  patients,  and  to  the  superior 
officer  going  round,  what  the  atmosphere  has  been  during  the 
night,  I  question  if  any  greater  security  could  be  afforded  against 
a  recurrence  of  the  misdemeanor. 

And  oh,  the  crowded  national  school !  where  so  many  children's 
epidemics  have  their  origin,  what  a  tale  its  air-test  would  tell ! 
We  should  have  parents  saying,  and  saying  rightly,  "  I  will  not 
send  my  child  to  that  school,  the  air-test  stands  at  '  Horrid.' " 
And  the  dormitories  of  our  great  boarding  schools !  Scarlet 
fever  would  be  no  more  ascribed  to  contagion,  but  to  its  right 
cause,  the  air-test  standing  at  "  Foul." 

We  should  hear  no  longer  of  "  Mysterious  Dispensations,"  and 
of  "  Plague  and  Pestilence,"  being  "  in  God's  hands,"  when,  so  far 
as  we  know.  He  has  put  them  into  our  own.  The  little  air-test 
would  both  betray  the  cause  of  these  "  mysterious  pestilences," 
and  call  upon  us  to  remedy  it. 


18  NOTES    ON   NUESING. 

or  to  the  occasional  dose  of  stimulant  which  she  is  direct- 
ed to  give  him,  while  the  patient  is  all  the  while  sinking 
from  want  of  a  little  external  warmth.  Such  cases  hap- 
pen at  all  times,  even  diu-ing  the  height  of  summer. 
This  fatal  chill  is  most  apt  to  occur  towards  early  morn- 
ing at  the  period  of  the  lowest  temperature  of  the  twenty- 
four  hours,  and  at  the  time  when  the  efifect  of  the  pre- 
ceding day's  diets  is  exhausted. 

Generally  speaking,  you  may  expect  that  weak 
patients  will  suffer  cold  much  more  in  the  morning  than 
in  the  evening.  The  vital  powers  are  much  lower.  If 
they  are  feverish  at  night,  with  burning  hands  and  feet, 
they  are  almost  sure  to  be  chilly  and  shivering  in  the 
morning.  But  nurses  are  very  fond  of  heating  the  foot- 
warmer  at  night,  and  of  neglecting  it  in  the  morning, 
when  they  are  busy.     I  should  reverse  the  matter. 

All  these  things  require  common  sense  and  care. 
Yet  perhaps  in  no  one  single  thing  is  so  little  common 
sense  shown,  in  all  ranks,  as  in  nursing.* 

*  With  private  sick,  I  think,  but  certainly  with  hospital  sick, 
the  nurse  should  never  be  satisfied  as  to  the  freshness  of  their 
atmosphere,  unless  she  can  feel  the  air  gently  moving  over  her 
face,  when  still. 

But  it  is  often  observed  that  the  nurses  who  make  the  greatest 
outcry  against  open  windows,  are  those  who  take  the  least  pains 
to  prevent  dangerous  draughts.  The  door  of  the  patients'  room 
or  ward  77iust  sometimes  stand  open  to  allow  of  persons  passing 
in  and  out,  or  heavy  things  being  carried  in  and  out.  The  care- 
ful nurse  will  keep  the  door  shut  while  she  shuts  the  windows, 
and  then,  and  not  before,  set  the  door  open,  so  that  a  patient 
may  not  be  left  sitting  up  in  bed,  perhaps  in  a  profuse  perspira- 
tion, directly  in  the  draught  between  the  open  door  and  window. 
Neither,  of  course,  should  a  patient,  while  being  washed  or  in 
any  way  exposed,  remain  in  the  draught  of  an  open  window  or 
door. 


VENTILATION   AND   WARMING.  19 

The  extraordinary  confusion  between  cold  and  ven-  CoW  air  not 
tilation,  even  in  the  minds  of  well   educated   people,  nor  fresh  air 
illustrates  this.     To  make  a  room  cold  is  by  no  means  cwii. 
necessarily  to  ventilate  it.     Nor  is  it  at  all  necessary,  in 
order  to  ventilate  a  room,  to  chill  it.     Yet,  if  a  nurse 
finds  a  room  close,  she  will   let  out  the   fire,   thereby 
making  it  closer,  or  she  will  open  the  door  into  a  cold 
room,  without  a  fire,  or  an  open  window  in  it,  by  way  of 
improving  the  ventilation.     The  safest  atmosphere  of  all 
for  a  patient  is  a  good  fire  and  an  open  window,  except- 
ing in  extremes  of  temperature.     (Yet  no  nurse  can  ever 
be  made  to  understand  this.)     To  ventilate  a  small  room 
without  draughts  of  course  requires  more  care  than  to 
ventilate  a  large  one. 

Another  extraordinary  fallacy  is  the  dread  of  night  Night  air. 
air.  What  air  can  we  breathe  at  night  but  night  air  ? 
The  choice  is  between  pure  night  air  from  without  and 
foul  night  air  from  within.  Most  people  prefer  the  latter. 
An  unaccountable  choice.  What  will  they  say  if  it  is 
proved  to  be  true  that  fully  one-half  of  all  the  disease 
we  suffer  from  is  occasioned  by  people  sleeping  with 
their  windows  shut  ?  An  open  window  most  nights  in 
the  year  can  never  hurt  any  one.  This  is  not  to  say 
that  light  is  not  necessary  for  recovery.  In  great  cities, 
night  air  is  often  the  best  and  purest  air  to  be  had  in  the 
twenty-four  hours.  I  could  better  understand  in  towns 
shutting  the  windows  during  the  day  than  during  the 
night,  for  the  sake  of  the  sick.  The  absence  of  smoke, 
the  quiet,  all  tend  to  making  night  the  best  time  for 
airing  the  patients.  One  of  our  highest  medical  authori- 
ties on  Consumption  and  Climate  has  told  me  that  the 
air  in  London  is  never  so  good  as  after  ten  o'clock  at 
night. 


20 


NOTES    ON    NUKSING. 


Air  from  tho 
outside. 
Open  your 
windows, 
shut  your 
doors. 


Bmoke. 


Airing  damp 
things  in  a 
patient's 
room. 


Always  air  your  room,  then,  from  the  outside  air,  if 
possible.  Windows  are  made  to  open ;  doors  are  made 
to  shut — a  truth  which  seems  extremely  difficult  of  ap- 
prehension. I  have  seen  a  careful  nurse  airing  her 
patient's  room  through  the  door,  near  to  which  were  two 
gaslights,  (each  of  which  consumes  as  much  air  as  eleven 
men,)  a  kitchen,  a  corridor,  the  composition  of  the  atmos- 
phere in  which  consisted  of  gas,  paint,  foul  air,  never 
changed,  full  of  effluvia,  including  a  current  of  sewer  air 
from  an  ill-placed  sink,  ascending  in  a  continual  stream 
by  a  well-staircase,  and  discharging  themselves  constant- 
ly into  the  patient's  room.  The  window  of  the  said 
room,  if  opened,  was  all  that  was  desirable  to  air  it. 
Every  room  must  be  aired  from  without — every  passage 
from  without.  But  the  fewer  passages  there  are  in  a 
hospital  the  better. 

If  we  are  to  preserve  the  air  within  as  pure  as  the  air 
without,  it  is  needless  to  say  that  the  chimney  must  not 
smoke.  Almost  all  smoky  chimneys  can  be  cured — ^from 
the  bottom,  not  from  the  top.  Often  it  is  only  necessary 
to  have  an  inlet  for  air  to  supply  the  fire,  which  is  feed- 
ing itself,  for  want  of  this,  from  its  own  chimney.  On 
the  other  hand,  almost  all  chimneys  can  be  made  to  smoke 
by  a  careless  nurse,  who  lets  the  fire  get  low  and  then 
overwhelms  it  with  coal ;  not,  as  we  verily  believe,  in  or- 
der to  spare  herself  trouble,  (for  very  rare  is  unkindness 
to  the  sick),  but  from  not  thinking  what  she  is  about. 

In  laying  down  the  principle  that  the  first  object  of 
the  nurse  must  be  to  keep  the  air  breathed  by  her 
patient  as  pure  as  the  air  without,  it  must  not  be  forgot- 
ten that  everything  in  the  room  which  can  give  off  efflu- 
via, besides  the  patient,  evaporates  itself  into  his  air. 
And  it  follows  that  there  ought  to  be  nothing   in  tho 


VENTILATION  AND  WAEMING.  21 

room,  excpting  him,  whicli  can  give  off  effluvia  or  moist- 
ure. Out  of  all  damp  towels,  &c.,  whicli  become  dry  in 
the  room,  the  damp,  of  course,  goes  into  the  patient's  air. 
Yet  this  "  of  course  "  seems  as  little  thought  of,  as  if  it 
were  an  obsolete  fiction.  How  very  seldom  you  see  a 
nurse  who  acknowledges  by  her  practice  that  nothing  at 
all  ought  to  be  aired  in  the  patient's  room,  that  nothing 
at  all  ought  to  be  cooked  at  the  patient's  fire !  Indeed 
the  arrangements  often  make  this  rule  impossible  to  ob- 
serve. 

If  the  nurse  be  a  very  careful  one,  she  will,  when  the 
patient  leaves  his  bed,  but  not  his  room,  open  the  sheets 
wide,  and  throw  the  bed-clothes  back,  in  order  to  air  his 
bed.  And  she  will  spread  the  wet  towels  or  flannels  care- 
fully out  upon  a  horse,  in  order  to  dry  them.  Now  either 
these  bed-clothes  and  towels  are  not  dried  and  aired,  or 
they  dry  and  air  themselves  into  the  patient's  air.  And 
whether  the  damp  and  effluvia  do  him  most  harm  in  his 
air  or  in  his  bed,  I  leave  to  you  to  determine,  for  I  can- 
not. 

Even  in  health  people  cannot  repeatedly  breathe  air  Effluvia 
in  which  they  live  with  impunity,  on  account  of  its  be-  {a?°^  ^^"^' 
coming  charged  with  unwholesome  matter  from  the  lungs 
and  skin.  In  disease  where  everything  given  off  from 
the  body  is  highly  noxious  and  dangerous,  not  only  must 
there  be  plenty  of  ventilation  to  carry  off  the  effluvia,  but 
everything  which  the  patient  passes  must  be  instantly  re- 
moved away,  as  being  more  noxious  than  even  the  ema- 
nations from  the  sick. 

Of  the  fatal  effects  of  the  effluvia  from  the  excreta  it 
would  seem  unnecessary  to  speak,  were  they  not  so  con- 
stantly neglected.  Concealing  the  utensils  behind  the 
vallance  to  the  bed  seems  all  the  precaution  which  is 


sewer. 


22  NOTES    ON   NUESING. 

thouglit  necessary  for  safety  in  private  nursing.  Did  you 
but  think  for  one  moment  of  the  atmosphere  under  that 
bed,  the  saturation  of  the  under  side  of  the  mattress  with 
the  warm  evaporations,  you  would  be  startled  and  fright- 
ened too ! 
Chamber  The  use  of  any  chamber  utensil  without  a  lid*  should 

utcDsils 

without  lids,  be  utterly  abolished,  whether  among  sick  or  well.  You 
can  easily  convince  yourself  of  the  necessity  of  this  abso- 
lute rule,  by  taking  one  with  a  lid,  and  examining  the 
under  side  of  that  lid.  It  will  be  found  always  covered, 
whenever  the  utensil  is  not  empty,  by  condensed  offen- 

Don't  make         *  But  never,  never  should  the  possession  of  this  indispensable 

vour  sick 

room  into  a    lid  confirm  you  in  the  abominable  practice  of  letting  the  chamber 

utensil  remain  in  a  patient's  room  unemptied,  except  once  in  the 
24  hours,  i.  e.,  when  the  bed  is  made.  Yes,  impossible  as  it  may 
appear,  I  have  known  the  best  and  most  attentive  nurses  guilty 
of  this  ;  aye,  and  have  known,  too,  a  patient  aflSicted  with  severe 
diarrhoea  for  ten  days,  and  the  nurse  (a  very  good  one)  not  know 
of  it,  because  the  chamber  utensil  (one  with  a  lid)  was  emptied 
only  once  in  24  hours,  and  that  by  the  housemaid  who  came  in 
and  made  the  patient's  bed  every  evening.  As  well  might  you 
have  a  sewer  under  the  room,  or  think  that  in  a  water-closet  the 
plug  need  be  pulled  up  but  once  a  day.  Also  take  care  that  your 
lid,  as  well  as  your  utensil,  be  always  thoroughly  rinsed. 

If  a  nurse  declines  to  do  these  kinds  of  things  for  her  patient, 
"  because  it  is  not  her  business,"  I  should  say  that  nursing  was 
not  her  calling.  I  have  seen  surgical  "sisters,"  women  whose 
hands  were  worth  to  them  two  or  three  guineas  a-week,  down 
upon  their  knees  scouring  a  room  or  hut,  because  they  thought  it 
otherwise  not  fit  for  their  patients  to  go  into.  I  am  far  from  wish- 
ing nurses  to  scour.  It  is  a  waste  of  power.  But  I  do  say  that 
these  women  had  the  true  nurse-calling — the  good  of  their  sick 
first,  and  second  only  the  consideration  what  it  was  their  "  place" 
to  do — and  that  women  who  wait  for  the  housemaid  to  do  this,  or 
for  the  charwoman  to  do  that,  when  their  patients  are  suffering, 
have  not  the  making  of  a  nurse  in  them. 


VENTILATION   AND   WAEMING.  23 

sive  moisture.     Wliere  does  that  go,  when  there  is  no 
lid"? 

Earthenware,  or  if  there  is  any  wood,  highly  polished 
and  varnished  wood,  are  the  only  materials  fit  for  pa- 
tients' utensils.  The  very  lid  of  the  old  abominable  close- 
Btool  is  enough  to  breed  a  pestilence.  It  becomes  satu- 
rated with  oflfensive  matter,  which  scouring  is  only  wanted 
to  bring  out.  I  prefer  an  earthenware  lid  as  being  al- 
ways cleaner.  But  there  are  various  good  new-fashioned 
arrangements. 

A  slop  pail  should  never  be  brought  into  a  sick  room.  ^Jp.p^^i^ 
It  should  be  a  rule  invariable,  rather  more  important  in 
the  private  house  than  elsewhere,  that  the  utensil  should 
be  carried  directly  to  the  water-closet,  emptied  there, 
rinsed  there,  and  brought  back.  There  should  always 
be  water  and  a  cock  in  every  water-closet  for  rinsing. 
But  even  if  there  is  not,  you  must  carry  water  there  to 
rinse  with.  I  have  actually  seen,  in  the  private  sick  room, 
the  utensils  emptied  into  the  foot-pan,  and  put  back  un- 
rinsed  under  the  bed.  I  can  hardly  say  which  is  most  abom- 
inable, whether  to  do  this  or  to  rinse  the  utensil  in  the  sick 
room.  In  the  best  hospitals  it  is  now  a  rule  that  no  slop- 
pail  shall  ever  be  brought  into  the  wards,  but  that  the 
utensils  shall  be  carried  direct  to  be  emptied  and  rinsed 
at  the  proper  place.  I  would  it  were  so  in  the  private 
house. 

Let  no  one  ever  depend  upon  fumigations,  "  disinfect-  Fnmiga' 
ants,"  and  the  like,  for  purifying  the  air.  The  offensive 
thing,  not  its  smell,  must  be  removed.  A  celebrated 
medical  lecturer  began  one  day,  "  Fumigations,  gentle- 
men, are  of  essential  importance.  They  make  such  an 
abominable  smell  that  they  compel  you  to  open  the  win- 
dow."    I  wish  all  the  disinfecting  fluids  invented  made 


24  NOTES   ON   NUESING. 

such  an  "  abominable  smell "  tbat  they  forced  you  to  ad- 
mit  fresh  air.     That  ^YOuld  be  a  useful  invention. 


IL— HEALTH  OF  HOUSES.* 
Health  of  There  are  five  essential  points  in  securinsr  the  health 

houses.  Five  ^  ° 

points  essen-  of  houseS  : — 

tiuL 

1.  Pure  air. 

2.  Pure  water. 

3.  Efficient  drainage. 

4.  Cleanliness. 

5.  Light. 

Without  these,  no  house  can  be  healthy.     And  it  will  be 
unhealthy  just  in  proportion  as  they  are  deficient. 
Pure  air.  1.  To  have  pure  air,  your  house  be  so  constructed  as 

that  the  outer  atmosphere  shall  find  its  way  with  ease  to 
every  corner  of  it.  House  architects  hardly  ever  con- 
sider this.  The  object  in  building  a  house  is  to  obtain 
the  largest  interest  for  the  money,  not  to  save  doctors' 
bills  to  the  tenants.  But,  if  tenants  should  ever  become 
so  wise   as  to  refuse  to  occupy  unhealthy  constructed 

Health  of  *  The  health  of  carriages,  especially  close  carriages,  is  not  of 

""^^  '  sufficient  universal  importance  to  mention  here,  otherwise  than 
cursorily.  Children,  who  are  always  the  most  delicate  test  of 
sanitary  conditions,  generally  cannot  enter  a  close  carriage  with- 
out being  sick — and  very  lucky  for  them  that  it  is  so.  A  close 
carriage,  with  the  horse-hair  cushions  and  linings  always  saturated 
with  organic  matter,  if  to  this  be  added  the  windows  up,  is  one 
of  the  most  unhealthy  of  human  receptacles.  The  idea  of  taking 
an  airing  in  it  is  something  preposterous.  Dr.  Angus  Smith  has 
shown  that  a  crowded  railway  carriage,  which  goes  at  the  rate  of 
30  miles  an  hour,  is  as  unwholesome  as  the  strong  smell  of  a  sewer, 
or  as  a  back  yard  in  one  of  the  most  unhealthy  courts  off  one  of 
the  most  unhealthy  streets  in  Manchester. 


HEALTH    OP    HOUSES.  25 

houses,  and  if  Insurance  Companies  sliould  ever  come  to 
understand  their  interest  so  thoroughly  as  to  pay  a  Sanitary 
Surveyor  to  look  after  the  houses  where  their  clients  live, 
speculative  architects  Avould  speedily  be  brought  to  their 
senses.  As  it  is,  they  build  what  pays  best.  And  there 
are  always  people  foolish  enough  to  take  the  houses  they 
build.  And  if  in  the  course  of  time  the  families  die  off, 
as  is  so  often  the  case,  nobody  ever  thinks  of  blaming 
any  but  Providence*  for  the  result.  Ill-informed  medical 
men  aid  in  sustaining  the  delusion,  by  laying  the  blame 
on  "current  contagions."  Badly  constructed  houses  do 
for  the  healthy  what  badly  constructed  hospitals  do  for 
the  sick.  Once  insure  that  the  air  in  a  house  is  stag- 
nant, and  sickness  is  certain  to  follow. 

2.  Pure   water  is    more    generally  introduced   into  Purewatec 
houses  than  it  used  to  be,  thanks  to  the  exertions  of  the 
sanitary  reformers.     Within  the  last  few  years,  a  large 

part  of  London  was  in  the  daily  habit  of  using  water 
polluted  by  the  drainage  of  its  sewers  and  water  closets. 
This  has  happily  been  remedied.  But,  in  many  parts  of 
the  country,  well  water  of  a  very  impure  kind  is  used  for 
domestic  purposes.  And  when  epidemic  disease  shows 
itself,  persons  using  such  water  are  almost  sure  to 
suffer. 

3.  It  would  be  curious  to  ascertain  by  inspection,  how  Drainage. 
many  houses  in  London  are  really  well  drained.     Many 

*  God  lays  down  certain  physical  laws.  Upon  His  carrying  out 
such  laws  depends  our  responsibility  (that  much  abused  word), 
for  how  could  we  have  any  responsibihty  for  actions,  the  results 
of  which  we  could  not  foresee — which  would  be  the  case  if  the 
carrying  out  of  His  laws  were  not  certain.  Yet  we  seem  to  be 
continually  expecting  that  He  will  work  a  miracle — i.  e.,  break 
His  own  laws  expressly  to  relieve  us  of  responsibility. 


26  NOTES    ON   NURSING. 

people  u^ould  say,  surely  all  or  most  of  them.  But  many 
people  have  no  idea  in  what  good  drainage  consists. 
They  think  that  a  sewer  in  the  street,  and  a  pipe  lead- 
ing to  it  from  the  house  is  good  drainage.  All  the  while 
the  sewer  may  be  nothing  but  a  laboratory  from  which 
epidemic  disease  and  ill  health  is  being  distilled  into  the 
house.  No  house  with  any  untrapped  drain  pipe  com- 
municating immediately  with  a  sewer,  whether  it  be  from 
water  closet,  sink,  or  gully-grate,  can  ever  be  healthy. 
An  untrapped  sink  may  at  any  time  spread  fever  or 
pyaemia  among  the  inmates  of  a  palace. 
Sinks.  The  ordinary  oblong  sink  is  an  abomination.     That 

great  surface  of  stone,  which  is  always  left  wet,  is  always 
exhaling  into  the  air.  I  have  known  whole  houses  and 
hospitals  smell  of  the  sink.  I  have  met  just  as  strong  a 
stream  of  sewer  air  coming  up  the  back  staircase  of  a 
grand  London  house  from  the  sink,  as  I  have  ever  met 
at  Scutari ;  and  I  have  seen  the  rooms  in  that  house  all 
ventilated  by  the  open  doors,  and  the  passages  all  imven- 
tilated  by  the  closed  windows,  in  order  that  as  much  of 
the  sewer  air  as  possible  might  be  conducted  into  and  re- 
tained in  the  bed-rooms.     It  is  wonderful. 

Another  great  evil  in  house  construction  is  carrying 
drains  underneath  the  house.  Such  drains  are  never  safe. 
All  house  drains  should  begin  and  end  outside  the  walls. 
Many  people  will  readily  admit,  as  a  theory,  the  impor- 
tance of  these  things.  But  how  few  are  there  who  can 
intelligently  trace  disease  in  their  households  to  such 
causes !  Is  it  not  a  fact,  that  when  scarlet  fever,  measles, 
or  small-pox  appear  among  the  children,  the  very  first 
thought  which  occurs  is,  "  where  "  the  children  can  have 
"  caught  "  the  disease  1  And  the  parents  immediately 
run  over  in  their  minds  all  the  families  with  whom  they 


HEALTH    OF    HOUSES.  27 

may  have  been.  They  never  think  of  looking  at  home 
for  the  source  of  the  mischief.  If  a  neighbour's  child  is 
seized  with  small-pox,  the  first  question  which  occurs  is 
Avhether  it  had  been  vaccinated.  No  one  would  under- 
value vaccination ;  but  it  becomes  of  doubtful  benefit  to 
society  when  it  leads  people  to  look  abroad  for  the  source 
of  evils  which  exist  at  home. 

4.  Without  cleanliness,  within  and  without  your  Cleanliness, 
house,  ventilation  is  comparatively  useless.  In  certain 
foul  districts  of  London,  poor  people  used  to  object  to 
open  their  windows  and  doors  because  of  the  foul  smells 
that  came  in.  Rich  people  like  to  have  their  stables  and 
dunghill  near  their  houses.  But  does  it  ever  occur  to 
them  that  with  many  arrangements  of  this  kind  it  would 
be  safer  to  keep  the  windows  shut  than  open  ?  You  can- 
not have  the  air  of  the  house  pure  with  dung-heaps  under 
the  windows.  These  are  common  all  over  London. 
And  yet  people  are  surprised  that  their  children,  brought 
up  in  large  "well-aired"  nurseries  and  bed-rooms  sufler 
from  children's  epidemics.  If  they  studied  Nature's  laws 
in  the  matter  of  children's  health,  they  would  not  be  so 
surprised. 

There  are  other  ways  of  having  filth  inside  a  house 
besides  having  dirt  in  heaps.  Old  papered  walls  of  years' 
standing,  dirty  carpets,  uncleansed  furniture,  are  just  as 
ready  sources  of  impurity  to  the  air  as  if  there  were  a 
dung-heap  in  the  basement.  People  are  so  unaccustomed 
from  education  and  habits  to  consider  how  to  make  a 
home  healthy,  that  they  either  never  think  of  it  at  all,  and 
take  every  disease  as  a  matter  of  course,  to  be  "  resigned 
to  "  when  it  comes  "  as  from  the  hand  of  Providence  ;" 
or  if  they  ever  entertain  the  idea  of  preserving  the  health 
of  their  household  as  a  duty,  they  are  very  apt  to  com- 


28  NOTES    ON   NUESING. 

mit  all  kinds  of  "negligences  and  ignorances"  in  per- 
forming it. 
Light.  5.  A  dark  house  is  always  an  unhealthy  house,  al- 

ways an  ill-aired  house,  always  a  dirty  house.  Want  of 
light  stops  growth,  and  promotes  scrofula,  rickets,  &c., 
among  the  children. 

People  lose  their  health  in  a  dark  house,  and  if  they 
get  ill  they  cannot  get  well  again  in  it.     IMore  will  be 
said  about  this  farther  on. 
Thrt-e  com-  Three  out  of  many  "  negligences  and  ignorances  " 

in  managing  in  managing  the  health  of  houses  generally,  I  will  here 
houses.  mention  as  specimens — 1.  That  the  female  head  in  charge 
of  any  building  does  not  think  it  necessary  to  visit  every 
hole  and  corner  of  it  every  day.  How  can  she  expect 
those  who  are  under  her  to  be  more  careful  to  maintain 
her  house  in  a  healthy  condition  than  she  who  is  in 
charge  of  it  ? — 2.  That  it  is  not  considered  essential  to 
air,  to  sun,  and  to  clean  rooms  while  uninhabited  ;  which 
is  simply  ignoring  the  first  elementary  notion  of  sanitary 
things,  and  laying  the  ground  ready  for  all  kinds  of  dis- 
eases.— 3.  That  the  window,  and  one  window,  is  con- 
sidered enough  to  air  a  room.  Have  you  never  observed 
that  any  room  w^ithout  a  fire-place  is  always  close  ? 
And,  if  you  have  a  fire-place,  w^ould  you  cram  it  up  not 
only  with  a  chimney-board,  but  perhaps  with  a  great  wisp 
of  brown  paper,  in  the  throat  of  the  chimney — to  prevent 
the  soot  from  coming  down,  you  say  1  If  your  chimney  is 
foul,  sweep  it ;  but  don't  expect  that  you  can  ever  air  a 
room  with  only  one  aperture ;  don't  suppose  that  to  shut 
up  a  room  is  the  way  to  keep  it  clean.  It  is  the  best 
way  to  foul  the  room  and  all  that  is  in  it.  Don't  imagine 
that  if  you,  who  are  in  charge,  don't  look  to  all  these 
things  yourself,  those  under  you  will  be  more  careful  than 


HEALTH    OF   HOUSES.  29 

you  are.  It  appears  as  if  the  part  of  a  mistress  now  is 
to  complain  of  lier  servants,  and  to  accept  their  excuses 
— not  to  sliow  them  how  there  need  be  neither  com- 
plaints made  nor  excuses. 

But  again,  to  look  to  all  these  things  yourself  does  JJ^r^e^must 
not  mean  to  do  them  vourself.     "I  alwavs  open   the  ^ee to iiouse 

"  .  ±  Hygiene, 

Avindows,"  the  head  in  charge  often  says.  If  you  do  it,  not  doit  her- 
it  is  by  so  much  the  better,  certainly,  than  if  it  were  not 
done  at  all.  But  can  you  not  insure  that  it  is  done  when 
not  done  by  yourself?  Can  you  insure  that  it  is  not 
undone  when  your  back  is  turned  ?  This  is  what  being 
"  in  charge  "  means.  And  a  very  important  meaning  it 
is,  too.  The  former  only  implies  that  just  what  you  can 
do  with  your  own  hands  is  done.  The  latter  that  what 
ought  to  be  done  is  always  done. 

And  now,  you  think  these  thinp^s  trifles,  or  at  least  ^o^^?  God 

'  •'  o  7  think  of 

exag'f^rerated.    But  what  you  "  think  "  or  what  I  "  think"  these  things 

°°  *'  so  seriously? 

matters  little.  Let  us  see  what  God  thinks  of  them. 
God  always  justifies  His  ways.  While  we  are  thinking, 
He  has  been  teaching.  I  have  known  cases  of  hospital 
pysemia  quite  as  severe  in  handsome  private  houses  as  in 
any  of  the  worst  hospitals,  and  from  the  same  cause^ 
viz.,  foul  air.  Yet  nobody  learnt  the  lesson.  Xobody 
learnt  anything  at  all  from  it.  They  went  on  thinking 
— thinking  that  the  sufferer  had  scratched  his  thumb, 
or  that  it  was  singular  that  "all  the  servants"  had 
"  whitlows,"  or  that  something  was  "  much  about  this 
year ;  there  is  always  sickness  in  our  house."  This  is  a 
favourite  mode  of  thought — leading  not  to  inquire  what 
is  the  uniform  cause  of  these  general  "  whitlows,"  but  to 
stifle  all  inquiry.  In  what  sense  is  "  sickness  "  being 
*'  always  there,"  a  justification  of  its  being  "  there " 
at  all  ? 


30  NOTES    OX   NUESING. 

How  does  I  will  tell  you  what  was   tlie   cause  of  tliis  hospital 

His  laws?  i)y8emia  being  in  that  large  private  house.  It  was  that 
the  sewer  air  from  an  ill-placed  sink  was  carefully  con- 
ducted into  all  the  rooms  by  sedulously  opening  all  the 
doors,  and  closing  all  the  passage  windows.  It  was  that 
the  slops  were  emptied  into  the  foot  pans  ! — it  was  that 
the  utensils  were  never  properly  rinsed  ; — it  was  that 
the  chamber  crockery  was  rinsed  with  dirty  water  ; — it 
was  that  the  beds  were  never  properly  shaken,  aired, 
picked  to  pieces,  or  changed.  It  was  that  the  carpets 
and  curtains  were  always  musty  ; — it  was  that  the  furni- 
ture was  always  dusty ; — it  was  that  the  papered  walls 
were  saturated  with  dirt ; — it  was  that  the  floors  were 
never  cleaned  ; — it  was  that  the  uninhabited  rooms  were 
never  sunned,  or  cleaned,  or  aired ; — it  vras  that  the  cup- 
boards were  always  reservoirs  of  foul  air  ; — it  was  that 
the  windows  were  always  tight  shut  up  at  night ; — it 
was  that  no  window  was  ever  systematically  opened 
even  in  the  day,  or  that  the  right  window  was  not  opened. 
A  person  gasping  for  air  might  open  a  window  for  him- 
self. But  the  servants  were  not  taught  to  open  the  win- 
dows, to  shut  the  doors ;  or  they  opened  the  windows 
upon  a  dank  well  between  high  walls,  not  upon  the  airier 
court ;  or  they  opened  the  room  doors  into  the  unaired 
halls  and  passages,  by  way  of  airing  the  rooms.  Now 
HcTeacr  ^^^  ^^^^  ^^  ^^*  fancy,  but  fact.  In  that  handsome  house 
His  laws?  J  ]2ave  known  in  one  summer  three  cases  of  hospital 
pyaemia,  one  of  phlebitis,  two  of  consumptive  cough; 
all  the  immediate  products  of  foul  air.  When,  in  tem- 
perate climates,  a  house  is  more  unhealthy  in  summer 
than  in  winter,  it  is  a  certain  sign  of  something  wrong. 
Yet  nobody  learns  the  lesson.  Yes,  God  always  justifies 
His  ways.     He  is  teaching  while  you  are  not  learning. 


HEALTH    OF    HOUSES.  31 

This  ijoor  body  loses  liis  finger,  that  one  loses  his  life. 
And  all  from  the  most  easily  preventible  causes.* 

The  houses  of  the  grandmothers  and  e^reat   errand-  Physical  de- 

°  o  o  generation 

mothers  of  this  generation,  at  least  the  country  houses,  i"  families, 
with  front  door  and  back  door  always  standing  open, 
winter  and  summer,  and  a  thorough  draught  ahvays 
blowing  through — with  all  the  scrubbing,  and  cleaning, 
and  polishing,  and  scouring  which  used  to  go  on,  the 
grandmothers,  and  still  more  the  great  grandmothers,  al- 
ways out  of  doors  and  never  with  a  bonnet  on  except  to  go 
to  church,  these  things  entirely  account  for  the  fact  so  often 
seen  of  a  great  grandmother,  who  was  a  tower  of  physi- 
cal vigour  descending  into  a  grandmother  perhaps  a  little 
less  vigorous  but  still  sound  as  a  bell  and  healthy  to  the 
core,  into  a  mother  languid  and  confined  to  her  carriage 
and  house,  and  lastly  into  a  daughter  sickly  and  confined 
to  her  bed.  For,  remember,  even  with  a  general  de- 
crease of  mortality  you  may  often  find  a  race  thus  de- 
generating and  still  oftener  a  family.  You  may  see 
poor  little  feeble  washed-out  rags,  children  of  a  noble 

*  I  must  say  a  word  about  servants'  bed-rooms.  From  the  way  Servant* 
they  are  built,  but  oftener  from  the  way  they  are  kept,  and  from  rooms, 
no  intelligent  inspection  whatever  being  exercised  over  them,  they 
are  almost  invariably  dens  of  foul  air,  and  the  "  servants'  health  " 
suffers  in  an  "  unaccountable  "  (?)  way,  even  in  the  country.  For 
I  am  by  no  means  speaking  only  of  London  houses,  where  too 
often  servants  are  put  to  live  under  the  ground  and  over  the  roof. 
But  in  a  country  "  ?/ia?isio?i,"  which  was  really  a  "  mansion,"  (not 
after  the  fashion  of  advertisements,)  I  have  known  three  maids 
who  slept  in  the  same  room  ill  of  scarlet  fever.  "  How  catching 
it  is,"  was  of  course  the  remark.  One  look  at  the  room,  one  smell 
of  the  room,  was  quite  enough.  It  was  no  longer  "  unaccount- 
able." The  room  was  not  a  small  one ;  it  was  up  stairs,  and  it 
had  two  large  windows — but  nearly  every  one  of  the  neglccta 
enumerated  above  was  there. 


32  NOTES    OX   NUESING. 

stock,  suffering  morally  and  physically,  throughout  their 
useless,  degenerate  lives,  and  yet  people  who  are  going 
to  marry  and  to  bring  more  such  into  the  world,  will  con- 
sult nothing  but  their  own  convenience  as  to  where  they 
are  to  live,  or  how  they  arc  to  live. 
Pon't  make         ^Yith  regard  to  the  health  of  houses  where  there  is  a 
?oom^into  a  sick  persou,  it  often  happens  that  the  sick  room  is  made 
shaft  for  the  a  ventilating  shaft  for  the  rest  of  the  house.     For  while 
'  the  house  is  kept  as  close,  unaired,  and  dirty  as  usual, 
the  window  of  the  sick  room  is  kept  a  little  open  al- 
ways, and  the  door  occasionally.     Now,  there  are  cer- 
tain sacrifices  which  a  house  with  one  sick  person  in  it 
does  make  to  that  sick  person  :  it  ties  up  its  knocker ;  it 
lays  straw  before  it  in  the  street.     Why  can't  it  keep 
itself  thoroughly  clean  and  unusually  well  aired,  in  def- 
erence to  the  sick  person  1 
Infection.  We  must  not  forget  what,  in  ordinary  language,  is 

called  "  Infection ;  "* — a  thing  of  which  people  are  gen- 
Diseases  are  *  jg  jt  not  livino^  in  a  continual  mistake  to  look  upon  diseases, 
not  individ-  °  .  .  ,  .  ,  .       ,.,  ■, 

uals  ar-  as  we  do  now,  as  separate  entities,  which  7nust  exist,  like  cats  and 

dasses  like    ^^S^  ^  instead  of  looking  upon  them  as  conditions,  like  a  dirty 

cats  and        and  a  clean  condition,  and  just  as  much  under  our  own  control; 

conditions      or  rather  as  the  reactions  of  kindly  nature,  against  the  conditions 

of  one°an-^*  in  which  we  have  placed  ourselves. 

other.  I  yfsm  brought  up,  both  by  scientific  men  and  ignorant  women, 

distinctly  to  believe  that  small-pox,  for  instance,  was  a  thing  of 
which  there  was  once  a  first  specimen  in  the  world,  which  went 
on  propagating  itself,  in  a  perpetual  chain  of  descent,  just  as 
much  as  that  there  was  a  first  dog,  (or  a  first  pair  of  dogs,)  and  that 
small-pox  would  not  begin  itself  any  more  than  a  new  dog  would 
begin  without  there  having  been  a  parent  dog. 

Since  then  I  have  seen  with  my  eyes  and  smelt  with  my  nose 
small-pox  growing  up  in  first  specimens,  either  in  close  rooms,  or 
in  overcrowded  wards,  where  it  could  not  by  any  possibihty  have 
been  "  caught,"  but  must  have  begun. 


HEALTH    OF    HOUSES.  33 

erally  so  afraid  that  they  frequently  follow  the  very 
practice  in  regard  to  it  which  they  ought  to  avoid. 
Nothing  used  to  be  considered  so  infectious  or  contagious 
as  small-pox ;  and  people  not  very  long  ago  used  to 
cover  up  patients  with  heavy  bed  clothes,  while  they  kept 
up  large  fires  and  shut  the  windows.  Small-pox,  of 
course,  under  this  regime,  is  very  "  infectious."  People 
are  somewhat  wiser  now  in  their  management  of  this  dis- 
ease. They  have  ventured  to  cover  the  patients  lightly 
and  to  keep  the  windows  open  ;  and  we  hear  much  less 
of  the  "infection"  of  small-pox  than  we  used  to  do. 
But  do  people  in  our  days  act  with  more  wisdom  on  the 
subject  of  "  infection  "  in  fevers — scarlet  fever,  measles, 
&c. — than  their  forefathers  did  with  small-pox "?  Does 
not  the  popular  idea  of  "  infection  "  involve  that  people 
should  take  greater  care  of  themselves  than  of  the  pa- 
tient ?  that,  for  instance,  it  is  safer  not  to  be  too  much 
with  the  patient,  not  to  attend  too  much  to  his  wants  ? 
Perhaps  the  best  illustration  of  the  utter  absurdity  of 
this  view  of  duty  in  attending  on  "  infectious  "  diseases 
is  afforded  by  what  was  very  recently  the  practice,  if  it 
is  not  so  even  now,  in  some  of  the  European  lazarets — 
in  which  the  plague-patient  used  to  be  condemned  to  the 
horrors  of  filth,  overcrowding,  and  want  of  ventilation, 
while  the  medical  attendant  was  ordered  to  examine  the 

Nay,  more,  I  hare  seen  diseases  begin,  grow  up,  and  pass  into 
one  another.     Now,  dogs  do  not  pass  into  cats. 

I  have  seen,  for  instance,  with  a  little  overcrowding,  continued 
fever  grow  up ;  and  with  a  little  more,  typhoid  fever ;  and  with  a 
little  more,  typhus,  and  all  in  the  same  ward  or  hut. 

Would  it  not  be  far  better,  truer,  and  more  practical,  if  we 
'i)okcd  upon  disease  in  this  light  ? 

For  diseases,  as  all  experiences  hows,  arc  adjectives,  not  noun 

substantives. 

2-yc 


files,  «Sz;c. 


S4  NOTES    ON    NURSING. 

patient's  tongue  through  an  opera-glass  and  to  toss  hira 
a  lancet  to  open  his  abscesses  with? 

True  nursing  ignores  infection,  except  to  prevent  it. 
Cleanliness  and  fresh  air  from  open  windows,  with  un- 
remitting attention  to  the  patient,  are  the  only  defence 
a  true  nurse  either  asks  or  needs. 

Wise  and  humane  management  of  the  patient  is  the 
best  safeguard  against  infection. 
Why  must  There  are  not  a  few  popular  opinions,  in  regard  to 

hav?niea-  which  it  is  useful  at  times  to  ask  a  question  or  two.  For 
example,  it  is  commonly  thought  that  children  must  have 
what  are  commonly  called  "  children's  epidemics,"  "  cur- 
rent contagions,"  &c.,  in  other  words,  that  they  are  born 
to  have  measles,  hooping-cough,  perhaps  even  scarlet 
fever,  just  as  they  are  born  to  cut  their  teeth,  if  they 
live. 

Now,  do  tell  us,  why  must  a  child  have  measles  ? 

Oh  because,  you  say,  we  cannot  keep  it  from  infec- 
tion— other  children  have  measles — and  it  must  take 
them — and  it  is  safer  that  it  should. 

But  why  must  other  children  have  measles  ?  And 
if  they  have,  why  must  yours  have  them  too  ? 

If  you  believed  in  and  observed  the  laws  for  preserv- 
ing the  health  of  houses  which  inculcate  cleanliness,  ven- 
tilation, white-washing,  and  other  means,  and  which,  by 
the  way,  are  laws,  as  implicitly  as  you  believe  in  the 
popular  opinion,  for  it  is  nothing  more  than  an  opinion, 
that  your  child  must  have  children's  epidemics,  don't  you 
think  that  upon  the  whole  your  child  would  be  more 
likely  to  escape  altogether  ? 


PETTY    MANAGEMENT.  35 


III.  PETTY  MANAGEMENT. 
All  the  results  of  good  nursino^,  as  detailed  in  these  Petty  man- 

agement. 

notes,  may  be  spoiled  or  utterly  negatived  by  one  de- 
fect, viz. :  in  petty  management,  or  in  other  words,  by 
not  knowing  how  to  manage  that  what  you  do  when  you 
are  there,  shall  be  done  when  you  are  not  there.  The 
most  devoted  friend  or  nurse  cannot  be  always  there. 
Nor  is  it  desirable  that  she  should.  And  she  may  give 
up  her  health,  all  her  other  duties,  and  yet,  for  want  of 
a  little  management,  be  not  one-half  so  efficient  as  an- 
other who  is  not  one-half  so  devoted,  but  who  has  this 
art  of  multiplying  herself — that  is  to  say,  the  patient  of 
the  first  will  not  really  be  so  well  cared  for,  as  the  patient 
of  the  second. 

It  is  as  impossible  in  a  book  to  teach  a  person  in  charge 
of  sick  how  to  manage,  as  it  is  to  teach  her  how  to  nurse. 
Circumstances  must  vary  with  each  different  case.  But  it 
is  possible  to  press  upon  her  to  think  for  herself;  Now 
what  does  happen  during  my  absence  %  I  am  obliged  to 
be  away  on  Tuesday.  But  fresh  air,  or  punctuality  is 
not  less  important  to  my  patient  on  Tuesday  than  it  was 
on  Monday.  Or:  At  10  p.m.  I  am  never  with  my  pa- 
tient ;  but  quiet  is  of  no  less  consequence  to  him  at  10 
than  it  was  at  5  minutes  to  10. 

Curious  as  it  may  seem,  this  very  obvious  considera- 
tion occurs  comparatively  to  few,  or,  if  it  does  occur,  it  is 
only  to  cause  the  devoted  friend  or  nurse  to  be  absent 
fewer  hours  or  fewer  minutes  from  her  patient — not  to 
arrange  so  as  that  no  minute  and  no  hour  shall  be  for  her 
patient  without  the  essentials  of  her  nursing. 


36  NOTES   ON   NUKSING. 

Illustrations        A  very  few  instances  will  be  sufficient,  not  as  pro- 
of it.  cepts,  but  as  illustrations. 

strangers  A  strange  washerwoman,  coming  late  at  niglit  for  the 

th^skk'''*''  "  things,"  will  burst  in  by  mistake  to  the  patient's  sick- 

'"^°^"  room,  after  he  has  fallen  into  his  first  doze,  giving  him  a 

shock,  the  effects  of  which  are  irremediable,  though  he 

himself  laughs  at  the  cause,  and   probably  never  even 

mentions  it.     The  nurse  who  is,  and  is  quite  right  to  be, 

at  her  supper,  has  not  provided  that  the  washerwoman 

shall  not  lose  her  w^ay  and  go  into  the  wrong  room. 

Sick  room  The  patient's  room  may  always  have  the   window 

airing  the  -r^         i  .  ,       ,  .        ,  i  i 

-whole  house,  open.     But  the  passage  outside  the  patient  s  room,  tnougn 
provided  with  several  large  windows,  may  never  have  one 
open.     Because  it  is  not  understood  that  the  charge  of 
the  sick-room  extends  to  the  charge  of  the  passage.  And 
thus,  as  often  happens,  the  nurse  makes  it  her  business 
to  turn  the  patient's  room  into  a  ventilating  shaft  for  the 
foul  air  of  the  whole  house. 
TJninhabited         An  uninhabited  room,  a  newly-painted  room,*  an  un- 
ite whole     cleaned  closet  or  cupboard,  may  often  become  the  reser- 
voir of  foul  air  for  the  whole  house,  because  the  person  in 
charge  never  thinks  of  arranging  that  these  places  shall 
be  always  aired,  always  cleaned ;  she  merely  opens  the 
window  herself  "  w^hen  she  goes  in." 
Delivery  An  agitating  letter  or  message  may  be  delivered,  or 

and  non-  .  i   t  i  •   •. 

delivery  of    an  important  letter  or  message  not  delivered;  a  visitor 

letters  and  ,  .  „  i  r         i 

messages.      whom  it  was  01  consequcuce  to  see,  may  be  reiusea,  or 

Lingering  *  That  excellent  paper,  the  Builder^  mentions  the  lingering  of 

smell  of         ^T^Q  smell  of  paint  for  a  month  about  a  house  as  a  proof  of  want 
paint  a  want  ^  ,        .    j 

of  care.  of  ventilation.     Certainly — and,  where  there  are  ample  windows 

to  open,  and  these  are  never  opened  to  get  rid  of  the  smell  of 

paint,  it  is  a  proof  of  want  of  management  in  using  the  means 

of  ventilation.     Of  course  the  smell  will  then  remain  for  months. 

Why  should  it  go  ? 


PETTY   MANAGEMENT.  37 

one  whom  it  was  of  still  more  consequence  to;io^  see  may 
be  admitted — because  the  person  in  charge  has  never 
asked  herself  this  question,  "What  is  done  when  I  am  not 
there?  * 

At  all  events,  one  may  safely  say,  a  nurse  cannot  be 
with  the  patient,  open  the  door,  eat  her  meals,  take  a 
message,  all  at  one  and  the  same  time.  Nevertheless 
the  person  in  charge  never  seems  to  look  the  impossibility 
in  the  face. 

Add  to  this  that  the  attoinpting  this  impossibility 
does  more  to  increase  the  poor  patient's  hurry  and  ner- 
vousness than  anything  else. 

It  is  never  thought  that  the  patient  remembers  these  ^^/y^fuSfas 
things  if  you  do  not.     He  has  not  only  to  think  whether  ^aysTnthe 
the  visit  or  letter  mav  arrive,  but  w^hether  you  will  be  in  way;' your- 

*'  '  •^  SGlI,  IDCrGIiSO 

the  way  at  the  particular  day  and  hour  when  it  may  ar-  gJfjQ^*^/ie 
rive.     So  that  your  partial  measures  fcr  "  being  in  the  patient's 
way  "  yourself,  only  increase  the  necessity  for  his  thought.  ^^"^^'^^^J', 

partial. 

*  Why  should  you  let  your  patient  ever  be  surprised,  except 
by  thieves  ?  I  do  not  know.  In  England,  people  do  cot  come  your  pi 
down  the  chimney,  or  through  the  window,  unless  tbey  are  pr^ed? 
thieves.  They  come  in  by  the  door,  and  somebody  must  open 
the  door  to  them.  The  "  somebody  "  charged  with  opening  the 
door  is  one  of  two,  three,  or  at  most  four  persons.  Why  caunot 
these,  at  most,  four  persons  be  put  in  charge  as  to  what  is  to  be 
done  when  there  is  a  ring  at  the  door-bell  ? 

The  sentry  at  a  post  is  changed  much  oftener  than  any  servant 
at  a  private  house  or  institution  can  possibly  be.  But  what 
should  we  think  of  such  an  excuse  as  this :  that  the  enemy  had 
entered  such  a  post  because  A  and  not  B  had  been  on  guard  ? 
Yet  I  have  constantly  heard  such  an  excuse  made  in  the  private 
house  or  institution,  and  accepted :  viz.,  that  such  a  person  had 
been  "  let  in "  or  not  "  let  in,"  and  such  a  parcel  had  been 
wrongly  delivered  or  lost  because  A  and  not  B  had  opened  the 
door  ! 


atient 
sur- 


38  NOTES   ON   NUKSIXG. 

"VVhereas,  if  you  could  but  arrange  that  the  thing  should 
always  be  done  whether  you  are  there  or  not,  he  need 
never  think  at  all  about  it. 

For  the  above  reasons,  whatever  a  patient  can  do  for 
himself,  it  is  better,  i.  e.  less  anxiety,  for  him  to  do  for 
himself,  unless  the  person  in  charge  has  the  spirit  of 
management. 

It  is  evidently  much  less  exertion  for  a  patient  to  an- 
swer a  letter  for  himself  by  return  of  post,  than  to  have 
four  conversations,  wait  five  days,  have  six  anxieties  be- 
fore it  is  off  his  mind,  before  the  person  w^ho  has  to  an- 
swer it  has  done  so. 

Apprehension,  uncertainty,  waiting,  expectation,  fear 
of  surprise,  do  a  patient  more  harm  than  any  exertion. 
Eemember,  he  is  face  to  face  with  his  enemy  all  the  time, 
internally  wrestling  with  him,  having  long  imaginary 
conversations  with  him.  You  are  thinking  of  something 
else.  "  Eid  him  of  his  adversary  quickly,"  is  a  first  rule 
with  the  sick.* 

For  the  same  reasons,  always  tell  a  patient  and  tell 
him  beforehand  when  you  are  going  out  and  when  you 
will  be  back,  whether  it  is  for  a  day,  an  hour,  or  ten 
minutes.  You  fancy  perhaps  that  it  is  better  for  him  if 
he  does  not  find  out  your  going  at  all,  better  for  him  if 
you  do  not  make  yourself  "  of  too  much  importance  "  to 

*  There  are  many  physical  operations  where  cceteris  paribus 
the  danger  is  in  a  direct  ratio  to  the  time  the  operation  lasts  ;  and 
cceteris  paribus  the  operator's  success  will  be  in  direct  ratio  to  his 
quickness.  Now  there  are  many  mental  operations  where  exactly 
the  same  rule  holds  good  with  the  sick  ;  cceteris  paribus  their 
capability  of  bearing  such  operations  depends  directly  on  the 
quickness,  without  hurry^  with  which  they  can  be  got  through. 


PETTY    MANAGEMENT.  39 

him  ;  or  else  you  cannot  bear  to  give  him  tlie  pain  or  the 
anxiety  of  the  temporary  separation. 

No  such  thing.  You  ought  to  go,  we  will  suppose. 
Health  or  duty  requires  it.  Then  say  so  to  the  patient 
openly.  If  you  go  without  his  knowing  it,  and  he  finds 
it  out,  he  never  will  feel  secure  again  that  the  things 
which  depend  upon  you  will  be  done  when  you  are  away, 
and  in  nine  cases  out  of  ten  he  will  be  right.  If  you  go 
out  without  telling  him  when  you  will  be  back,  he  can 
take  no  measures  nor  precautions  as  to  the  things  which 
concern  you  both,  or  which  you  do  for  him. 

If  you  look  into  the  reports  of  trials  or  accidents.  What  is  th« 
and  especially  of  suicides,  or  into  the  medical  history  of  the  accidents 
fatal  cases,  it  is  almost  incredible  how  often  the  whole  pen?  *^ 
thing  turns  upon  something  which  has  happened  because 
"  he,"  or  still  oftener  "  she,"  "  was  not  there."  But  it  is 
still  more  incredible  how  often,  how  almost  always  this  is 
accepted  as  a  sufficient  reason,  a  justification  ;  why,  the 
very  fact  of  the  thing  having  happened  is  the  proof  of  its 
jQot  being  a  justification.  The  person  in  charge  was  quite 
right  not  to  be  "  therej"  he  was  called  away  for  quite  suf- 
ficient reason,  or  he  was  away  for  a  daily  recurring  and 
unavoidable  cause  ;  yet  no  provision  was  made  to  supply 
his  absence.  The  fault  was  not  in  his  "  being  away,"  but 
in  there  being  no  management  to  supplement  his  "  being 
away."  When  the  sun  is  under  a  total  eclipse  or  during 
his  nightly  absence,  we  light  candles.  But  it  would  seem 
as  if  it  did  not  occur  to  us  that  we  must  also  supplement 
the  person  in  charge  of  sick  or  of  children,  whether 
under  an  occasional  eclipse  or  during  a  regular  absence. 

In  institutions  where  many  lives  would  be  lost  and 
the  eftect  of  such  want  of  management  would  be  terrible 


40 


NOTES    OX   NURSING. 


Petty  man- 
a;j;uinent 
better  un- 
derstood in 
institutions 
than  in  jjri- 
vate  houses. 

What  insti- 
tutions are 
the  exeep- 
tion? 


Nursins:  in 
Regimental 
Hospitals. 


and   patent,    there  is  less  of  it    than    in    the    private 
house.* 

But  in  both,  let  whoever  is  in  charge  keep  this  sim- 

*  So  true  is  this  that  I  could  mention  two  cases  of  women  of 
very  high  position,  both  of  whom  died  in  the  same  way  of  the 
consequences  of  a  surgical  operation.  And  in  both  cases,  I  wa3 
told  by  the  highest  authority  that  the  fatal  result  would  not  have 
happened  in  a  London  hospital. 

But,  as  far  as  regards  the  art  of  petty  management  in  hospitals, 
all  the  military  hospitals  I  know  must  be  excluded.  Upon  my 
own  experience  I  stand,  and  I  solemnly  declare  that  I  have  seen 
or  known  of  fatal  accidents,  such  as  suicides  in  delirium  tremens, 
bleedings  to  death,  dying  patients  dragged  out  of  bed  by  drunken 
Medical  Staff"  Corps  men,  and  many  other  things  less  patent  and 
striking,  which  would  not  have  happened  in  London  civil  hospitals 
nursed  by  women.  The  medical  officers  should  be  absolved  from 
all  blame  in  these  accidents.  How  can  a  medical  officer  mount 
guard  all  day  and  all  night  over  a  patient  (say)  in  delirium  tremens  ? 
The  fault  lies  in  there  being  no  organized  system  of  attendance. 
Were  a  trustworthy  man  in  charge  of  each  ward,  or  set  of  wards, 
not  as  office  clerk,  but  as  head  nurse,  (and  head  nurse  the  best 
hospital  Serjeant,  or  ward  master,  is  not  now  and  cannot  be,  from 
default  of  the  proper  regulations,)  the  thing  would  not,  in  all 
probability,  have  happened.  But  were  a  trustworthy  woman  in 
charge  of  the  ward,  or  set  of  wards,  the  thing  would  not,  in  all 
certainty,  have  happened.  In  other  words,  it  does  not  happen 
where  a  trustworthy  woman  is  really  in  charge.  And,  in  these 
remarks,  I  by  no  means  refer  only  to  exceptional  times  of  great 
emergency  in  war  hospitals,  but  also,  and  quite  as  much,  to  the 
ordinary  run  of  military  hospitals  at  home,  in  time  of  peace  ;  or 
to  a  time  in  war  when  our  army  was  actually  more  healthy  than 
at  home  in  peace,  and  the  pressure  on  our  hospitals  consequently 
much  less. 

It  is  often  said  that,  in  regimental  hospitals,  patients  ought  to 
"  nurse  each  other,"  because  the  number  of  sick  altogether  being, 
say,  but  thirty,  and  out  of  these  one  only  perhaps  being  seriously 
ill,  and  the  other  twenty-nine  having  little  the  matter  with  them, 
and  nothing  to  do,  they  should  be  set  to  nurse  the  one;  also, that 


PETTY   MANAGEMENT.  41 

pie  question  in  her  head  (^tiot,  how  can  I  always  do  this 
right  thing  myself,  but)  how  can  I  provide  for  this  right 
thing  to  be  always  done  ? 

Then,  when  anything  wrong  has  actually  happened 
in  consequence  of  her  absence,  which  absence  we  will 
suppose  to  have  been  quite  right,  let  her  question  still  be 
(^noi,  how  can  I  provide  against  any  more  of  such  ab- 
sences ?  which  is  neither  possible  nor  desirable,  but)  how 
can  I  provide  against  anything  wrong  arising  out  of  my 
absence  ? 

How  few  men,  or  even  women,  understand,  either  in  "^iiat  it  is  t« 

be  '"in 

great  or  in  little  things,  what  it  is  the  being  "  in  charge  "  charge." 
— I  mean,  know  how  to  carry  out  a  "charge."     From 
the  most  colossal  calamities,  down  to  the  most  trifling; 
accidents,  results  are  often  traced  (or  rather  not  traced) 
to  such  want  of  some  one  "  in  charge  "  or  of  his  knowing 

soldiers  are  so  trained  to  obey,  that  they  will  be  the  most  obedient, 
and  therefore  the  best  of  nurses,  add  to  which  they  are  always 
kind  to  their  comrades. 

Now,  have  those  who  say  this,  considered  that,  in  order  to 
obey,  you  must  know  how  to  obey,  and  that  these  soldiers  cer- 
tainly do  not  know  how  to  obey  in  nursing,  I  have  seen  these 
"  kind  "  fellows  (and  how  kind  they  are  no  one  knows  so  well  as 
myself)  move  a  comrade  so  that,  in  one  case  at  least,  the  man 
died  in  the  act.  I  have  seen  the  comrades'  "  kindness  "  produce 
abundance  of  spirits,  to  be  drunk  in  secret.  Let  no  one  under- 
stand by  this  that  female  nurses  ought  to,  or  could  be  introduced 
in  regimental  hospitals.  It  would  be  most  undesirable,  even  were 
it  not  impossible.  But  the  head  nurseship  of  a  hospital  serjeant 
is  the  more  essential,  the  more  important,  the  more  inexperienced 
the  nurses.  Undoubtedly,  a  London  hospital  "sister"  does  some- 
times set  relays  of  patients  to  watch  a  critical  case  ;  but,  undoubt- 
edly also,  always  under  her  own  superintendence;  and  she  is 
called  to  whenever  there  is  something  to  be  done,  and  she  knows 
how  to  do  it.  The  patients  are  not  left  to  do  it  of  their  own 
unassisted  genius,  however  "  kind  "  and  willing  they  may  be. 


42  NOTES    ON   NURSIXG. 

liow  to  be  "  in  charge."  A  short  time  ago  the  bursting 
of  a  funnel-casing  on  board  the  finest  and  strongest  ship 
that  ever  was  built,  on  her  trial  trip,  destroyed  several 
lives  and  put  several  hundreds  in  jeopardy — not  from  any 
undetected  flaw  in  her  new  and  untried  works — but  from 
a  tap  being  closed  which  ought  not  to  have  been  closed — 
from  what  every  child  knows  would  make  its  mother's 
tea-kettle  burst.  And  this  simply  because  no  one  seemed 
to  know  what  it  is  to  be  "  in  charge,"  or  luho  was  in 
charge.  Nay  more,  the  jury  at  the  inquest  actually  al- 
together ignored  the  same,  and  apparently  considered 
the  tap  "  in  charge,"  for  they  gave  as  a  verdict  "  acci- 
dental death." 

This  is  the  meaning  of  the  word,  on  a  large  scale. 
On  a  much  smaller  scale,  it  happened,  a  short  time  ago, 
that  an  insane  person  burned  herself  slowly  and  inten- 
tionally to  death,  while  in  her  doctor's  charge  and  almost 
in  her  nurse's  presence.  Yet  neither  was  considered  "  at 
all  to  blame."  The  very  fact  of  the  accident  happening 
proves  its  own  case.  There  is  nothing  more  to  be  said. 
Either  they  did  not  know  their  business  or  they  did  not 
know  how  to  perform  it. 

"To  be  "in  charge  "  is  certainly  not  only  to  carry 
out  the  proper  measures  yourself  but  to  see  that  every 
one  else  does  so  too ;  to  see  that  no  one  either  wilfully 
or  ignorantly  thwarts  or  prevents  such  measures.  It  is 
neither  to  do  everything  yourself  nor  to  appoint  a  num- 
ber of  people  to  each  duty,  but  to  ensure  that  each  does 
that  duty  to  which  he  is  appointed.  This  is  the  meaning 
which  must  be  attached  to  the  word  by  (above  all)  those 
"  in  charge  "  of  sick,  whether  of  numbers  or  of  individu- 
als, (and  indeed  I  think  it  is  with  individual  sick  that  it 
is  least  understood.     One  sick  person  is  often  waited  on 


PETTY   MANAGEMENT.  43 

by  four  with  less  precision,  and  is  really  less  cared  for 
than  ten  who  are  waited  on  by  one ;  or  at  least  than  40 
who  are  waited  on  by  4 ;  and  all  for  want  of  this  one 
person  "  in  charge.") 

It  is  often  said  that  there  are  few  good  servants  now  ; 
I  say  there  are  few  good  mistresses  now.  As  the  jury 
seems  to  have  thought  the  tap  w^as  in  charge  of  the  ship's 
safety,  so  mistresses  now  seem  to  think  the  house  is  in 
charge  of  itself.  They  neither  know  how  to  give  orders, 
nor  how  to  teach  their  servants  to  obey  orders — i.  e.,  to 
obey  intelligently,  which  is  the  real  meaning  of  all  dis- 
cipline. 

Again,  people  who  are  in  charge  often  seem  to  have 
SL  pride  in  feeling  that  they  will  be  "  missed,"  that  no 
one  can  understand  or  carry  on  their  arrangements, 
their  system,  books,  accounts,  &c.,  but  themselves.  It 
seems  to  me  that  the  pride  is  rather  in  carrjang  on  a 
system,  in  keeping  stores,  closets,  books,  accounts,  &c.,  so 
that  any  body  can  undarstand  and  carry  them  on — so 
that,  in  case  of  absence  or  illness,  one  can  deliver  every 
thing  up  to  others  and  know  that  all  will  go  on  as  usual, 
and  that  one  shall  never  be  missed. 

Note. — It  is  often  complained,  that  professional  nurses,  brought  Why  hired 
into  private  families,  in  case  of  sickness,  make  themselves  intol-  p" mu^eh.^^* 
erable  by  "  ordering  about "  the  other  servants,  under  plea  of  not  trouble, 
neglecting  the  patient.     Both  things  are  true ;  the  patient  is  often 
neglected,  and  the  servants  are  often  unfairly  "  put  upon,"     But 
the  fault  is  generally  in  the  want  of  management  of  the  head  in 
charge.     It  is  surely  for  her  to  arrange  both  that  the  nurse's  place 
is,  when  necessary,  supplemented,  and  that  the  patient  is  never  neg- 
lected— things  with  a  little  management  quite  compatible,  and 
indeed  only  attainable  together.     It  is  certainly  not  for  the  nurse 
to  •*  order  about "  the  servants. 


44  NOTES    ON   NUESIXG. 


IV.   NOISE. 


J'jj"^^^^^^^'y  Unnecessary  noise,  or  noise  tliat  creates  an  expecta- 
tion in  the  mind,  is  that  which  hurts  a  patient.  It  is 
rarely  the  loudness  of  the  noise,  the  effect  upon  the  organ 
of  the  ear  itself,  which  appears  to  affect  the  sick.  How 
well  a  patient  will  generally  bear,  e.  g.,  the  putting  up 
of  a  scaffolding  close  to  the  house,  when  he  cannot  bear 
the  talking,  still  less  the  whispering,  especially  if  it  be 
of  a  familiar  voice,  outside  his  door. 

There  are  certain  patients,  no  doubt,  especially  where 
there  is  slight  concussion  or  other  disturbance  of  the 
brain,  who  are  affected  by  mere  noise.  But  intermittent 
noise,  or  sudden  and  sharp  noise,  in  these  as  in  all  other 
cases,  affects  far  more  than  continuous  noise — noise  with 
jar  far  more  than  noise  without.  Of  one  thing  you  may 
be  certain,  that  anything  which  wakes  a  patient  sudden- 
ly out  of  his  sleep  w^ill  invariably  put  him  into  a  state  of 
greater  excitement,  do  him  more  serious,  aye,  and  lasting 
mischief,  than  any  continuous  noise,  however  loud. 

Xeverieta  Never  to  allow  a  patient  to  be  waked,  intentionally 

patient  be  in.  r»      it  i  • 

\vaked  out  of  or  accidentally,  is  a  sine  qua  non  of  all  good  nursmg. 

sleep.  If  he  is  roused  out  of  his  first  sleep,  he  is  almost  certain 

to  have  no  more  sleep.  It  is  a  curious  but  quite  intelli- 
gible fact  that,  if  a  patient  is  waked  after  a  few  hours' 
instead  of  a  few  minutes'  sleep,  he  is  much  more  likely 
to  sleep  again.  Because  pain,  like  irritability  of  brain, 
perpetuates  and  intensifies  itself  If  you  have  gained  a 
respite  of  either  in  sleep  you  have  gained  more  than  the 
mere  respite.  Both  the  probability  of  recurrence  and  of 
the  same  intensity  will  be  diminished  ;  whereas  both  will 
be  terribly  increased  by  want  of  sleep.     This  is  the  rea- 


NOISE.  45 

son  -svliy  sleep  is  so  all-important.  This  is  the  reason 
why  a  patient  waked  in  the  early  part  of  his  sleep  loses 
not  only  his  sleep,  but  his  power  to  sleep.  A  healthy 
person  who  allow^s  himself  to  sleep  during  the  day  will 
lose  his  sleep  at  night.  But  it  is  exactly  the  reverse 
with  the  sick  generally  ;  the  more  they  sleep,  the  better 
will  they  be  able  to  sleep. 

I  have  often  been  surprised  at  the  thoughtlessness,  ^^Jftcs^ix-'^ 
(resulting  in  cruelty,  quite  unintentionally)  of  friends  or  pt^ctation. 
of  doctors  who  will  hold  a  long  conversation  just  in  the 
room  or  passage  adjoining  to  the  room  of  the  patient,  who 
is  either  every  moment  expecting  them  to  come  in,  or 
who  has  just  seen  them,  and  knows  they  are  talking 
about  him.  If  he  is  an  amiable  patient,  he  will  try  to 
occupy  his  attention  elsewhere  and  not  to  listen — and 
this  makes  matters  worse — for  the  strain  upon  his  atten- 
tion and  the  effort  he  makes  are  so  great  that  it  is  well 
if  he  is  not  worse  for  hours  after.     If  it  is  a  w^hispered  Whispered 

,..,-,.      conversation 

conversation  m  the  same  room,  then  it  is  absolutely  in  the  room, 
cruel ;  for  it  is  impossible  that  the  patient's  attention 
should  not  be  involuntarily  strained  to  hear.  Walking 
on  tip-toe,  doing  any  thing  in  the  room  very  slowly,  are 
injurious,  for  exactly  the  same  reasons.  A  firm  light 
quick  step,  a  steady  quick  hand  are  the  desiderata  ;  not 
the  slow,  lingering,  shuffling  foot,  the  timid,  uncertain 
touch.  Slowness  is  not  gentleness,  though  it  is  often 
mistaken  for  such :  quickness,  lightness,  and  gentleness 
are  quite  compatible.  Again,  if  friends  and  doctors  did 
but  watch,  as  nurses  can  and  should  watch,  the  features 
sharpening,  the  eyes  growing  almost  wild,  of  fever 
patients  who  are  listening  for  the  entrance  from  the 
corridor  of  the  persons  whose  voices  they  are  hearing 
there,  these  would  never  run  the  risk  again  of  creating 


46 


NOTES    ON    NURSING. 


Or  just  out- 
side the 
door. 


Noise  of  fe- 
male dress. 


such  expectation,  or  irritation  of  mind. — Sach  unneces- 
sary noise  has  undoubtedly  induced  or  aggravated  deliri- 
um in  many  cases.  I  liave  known  such — in  one  case 
death  ensued.  It  is  but  fair  to  say  that  this  death  was 
attributed  to  fright.  It  was  the  result  of  a  long  whis- 
pered conversation,  within  sight  of  the  patient,  about  an 
impending  operation ;  but  any  one  who  has  known  the 
more  than  stoicism,  the  cheerful  coolness,  with  which  the 
certainty  of  an  operation  will  be  accepted  by  any  patient, 
capable  of  bearing  an  operation  at  all,  if  it  is  properly 
communicated  to  him,  will  hesitate  to  believe  that  it  was 
mere  fear  which  produced,  as  was  averred,  the  fatal  result 
in  this  instance.  It  was  rather  the  uncertainty,  the 
strained  expectation  as  to  what  was  to  be  decided  upon. 

I  need  hardly  say  that  the  other  common  cause, 
namely,  for  a  doctor  or  friend  to  leave  the  patient  and 
communicate  his  opinion  on  the  result  of  his  visit  to  the 
friends  just  outside  the  patient's  door,  or  in  the  adjoining 
room,  after  the  visit,  but  within  hearing  or  knowledge 
of  the  patient  is,  if  possible,  worst  of  all. 

It  is,  I  think,  alarming,  peculiarly  at  this  time,  when 
the  female  ink-bottles  are  perpetually  impressing  upon 
us  "  woman's  "  "particular  worth  and  general  missionari- 
ness,"  to  see  that  the  dress  of  women  is  daily  more  and 
more  unfitting  them  for  any  "  mission,"  or  usefulness  at 
all.  It  is  equally  unfitted  for  all  poetic  and  all  domestic 
purposes.  A  man  is  now  a  more  handy  and  far  less 
objectionable  being  in  a  sick  room  than  a  woman. 
Compelled  by  her  dress,  every  woman  now  either  shuffles 
or  waddles — only  a  man  can  cross  the  floor  of  a  sick- 
room without  shaking  it!  What  is  become  of  woman's 
light  step*? — the  firm,  light,  quick  step  we  have  been 
askins:  for  ? 


NOISE.  47 

Unnecessary  noise,  then,  is  the  most  cruel  absence  of 
care  which  can  be  inflicted  either  on  sick  or  well.  For, 
in  aU  these  remarks,  the  sick  are  only  mentioned  as  suf- 
fering in  a  greater  proportion  than  the  well  from  pre- 
cisely the  same  causes. 

Unnecesary  (although  slight)  noise  injures  a  sick  per- 
son much  more  than  necessary  noise  (of  a  much  greater 
amount). 

All  doctrines  about  mysterious  affinities  and  aversions  Patient's  ro- 

•^  ^  pulsion  to 

will  be  found  to  resolve  themselves  very  much,  if  not  nurses  wht 

•^  ^  rustle. 

entirely,  into  presence  or  absence  of  care  in  these  things. 

A  nurse  who  rustles  (I  am  speaking  of  nurses  profes- 
sional and  unprofessional)  is  the  horror  of  a  patient, 
though  perhaps  he  does  not  know  why. 

The  fidget  of  silk  and  of  crinoline,  the  rattling  of 
keys,  the  creaking  of  stays  and  of  shoes,  will  do  a  patient 
more  harm  than  all  the  medicines  in  the  world  wall  do 
him  good. 

The  noiseless  step  of  woman,  the  noiseless  drapery  of 
woman,  are  mere  figures  of  speech  in  this  day.  Her  skirts 
(and  well  if  they  do  not  throw  down  some  piece  of  furni- 
ture) will  at  least  brush  against  every  article  in  the  room 
as  she  moves.* 

*  Fortunate  it  is  if  her  skirts  do  not  catcli  fire — and  if  the  nurse  Burning  of 
does  not  give  herself  up  a  sacrifice  together  with  her  patient,  to  unes. 
be  burnt  in  her  own  petticoats.  I  wish  the  Registrar-General 
would  tell  us  the  exact  number  of  deaths  by  burning  occasioned 
by  this  absurd  and  hideous  custom.  But  if  people  will  be  stupid, 
let  them  take  measures  to  protect  themselves  from  their  own  stu- 
pidity— measures  which  every  chemist  knows,  such  as  putting 
alum  into  starch,  which  prevents  starched  articles  of  dress  from 
blazing  up. 

I  wish,  too,  that  people  who  wear  crinoline  could  sec  the  inde-  In'lecency 
„    ,     .  ,  ,  of  tho  crintk- 

cency  of  their  own  dress  as  other  people  see  it.     A  respectable  Hues. 


48  NOTES    ON   NTTESING. 

Again,  one  nurse  cannot  open  the  door  without  mak- 
ing everything  rattle.  Or  she  opens  the  door  unneces- 
sarily often,  for  want  -of  rememhering  all  the  articles  that 
might  be  brought  in  at  once. 

A  good  nurse  will  always  make  sure  that  no  door  or 
window  in  her  patient's  room  shall  rattle  or  creak  ;  that 
no  blind  or  curtain  shall,  by  any  change  of  wind  through 
the  open  window  be  made  to  flap — especially  will  she  be 
careful  of  all  this  before  she  leaves  her  patients  for  the 
night.  If  you  wait  till  your  patients  tell  you,  or  remind 
you  of  these  things,  where  is  the  use  of  their  having  a 
nurse  1  There  are  more  shy  than  exacting  patients,  in  all 
classes  ;  and  many  a  patient  passes  a  bad  night,  time 
after  time,  rather  than  remind  his  nurse  every  night  of  all 
the  things  she  has  forgotten. 

If  there  are  blinds  to  your  windows,  always  take  care 
to  have  them  well  up,  when  they  are  not  being  used.  A 
little  piece  slipping  down,  and  flapping  with  every 
draught,  will  distract  a  patient. 

Hurry  pecu-         All  hurry  or  bustle  is  peculiarly  painful  to  the  sick. 

fui  to  sick.  And  when  a  patient  has  compulsory  occupations  to  engage 
him,  instead  of  having  simply  to  amuse  himself,  it  be- 
comes doubly  injurious.  The  friend  who  remains  stand- 
ing and  fidgetting  about  while  a  patient  is  talking  busi- 
ness to  him,  or  the  friend  who  sits  and  proses,  the  one 
from  an  idea  of  not  letting  the  patient  talk,  the  other 
from  an  idea  of  amusing  him, — each  is  equally  incon- 
siderate. Always  sit  do^^^l  when  a  sick  person  is  talking 
business  to  you,  show  no  signs  of  hurry ,  give  complete 

elderly  woman  stooping  forward,  invested  in  crinoline,  exposes 
quite  as  much  of  her  o%An  person  to  the  patient  lying  in  the  room 
as  any  opera  diincer  does  on  the  stage.  But  no  one  will  ever  tell 
her  this  unpleasant  truth. 


NOISE.  49 

attention  and  full  consideration  if  your  advice  is  wanted, 
and  go  away  the  moment  the  subject  is  ended. 

Always  sit  within  the  patient's  view,  so  that  when  J^g^^j^^^'^jj" 
you  speak  to  him  he  has  not  painfully  to  turn  his  head  not  hurt 
round  in  order  to  look  at  you.  Everybody  involuntarily 
looks  at  the  person  speaking.  If  you  make  this  act  a 
wearisome  one  on  the  part  of  the  patient  you  are  doing 
him  harm.  So  also  if  by  continuing  to  stand  you  make 
him  continuously  raise  his  eyes  to  see  you.  Be  as  motion- 
less as  possible,  and  never  gesticulate  in  speaking  to  the 
sick. 

Never  make  a  patient  repeat  a  message  or  request, 
especially  if  it  be  some  time  after.  Occupied  patients 
are  often  accused  of  doing  too  much  of  their  own  business. 
They  are  instinctively  right.  How  often  you  hear  the 
person,  charged  with  the  request  of  giving  the  message 
or  writing  the  letter,  say  half  an  hour  afterwards  to  the 
patient,  "Did  you  appoint  12  o'clock?"  or,  "What  did 
you  say  was  the  address '? "  or  ask  perhaps  son>e  much 
more  agitating  question — thus  causing  the  patient  the 
effort  of  memory,  or  worse  still,  of  decision,  all  over  again. 
It  is  really  less  exertion  to  him  to  write  his  letters  him- 
self. This  is  the  almost  universal  experience  of  occupied 
invalids. 

This  brings  us  to  another  caution.  Never  speak  to 
an  invalid  from  behind,  nor  from  the  door,  nor  from  any 
distance  from  him,  nor  when  he  is  doing  anything. 

The  official  politeness  of  servants  in  these  things  is  so 
grateful  to  invalids,  that  many  prefer,  without  knowing 
why,  having  none  but  servants  about  them. 

These  thino^s  are  not  fancy.     If  we  consider  that,  with  These  things 

°  •'  not  fancy. 

sick  as  with  well,  every  thought  decomposes  some  nerv- 
ous matter, — that  decomposition  as  well  as  re-composition 
3 


50  NOTES    ON   NURSING. 

of  nervous  matter  is  always  going  on,  and  more  quickly 
with  the  sick  than  with  the  well, — that,  to  obtrude  ab- 
ruptly another  thought  upon  the  brain  while  it  is  in  the 
act  of  destroying  nervous  matter  by  thinking,  is  calling 
upon  it  to  make  a  new  exertion, — if  we  consider  these 
things,  which  are  facts,  not  fancies,  we  shall  remember 
that  we  are  doing  positive  injury  by  interrupting,  by 
"  startling  a  fanciful  "  person,  as  it  is  called.  Alas !  it 
is  no  fancy, 
interrnption        jf  i}^q  invalid  is  forccd,  bv  his  avocations,  to  continue 

damaging  '      ^  ' 

to  sick.  occiipations  requiring  much  thinking,  the  injury  is  doubly 
great.  In  feeding  a  patient  suffering  under  delirium  or 
stupor  you  may  suffocate  him,  by  giving  him  his  food 
suddenly,  but  if  you  rub  his  lips  gently  with  a  spoon  and 
thus  attract  his  attention,  he  will  swallow  the  food  un- 
consciously, but  with  perfect  safety.  Thus  it  is  with  the 
brain.  If  you  offer  it  a  thought,  especially  one  requiring 
a  decision,  abruptly,  you  do  it  a  real  not  fanciful  injury. 
Never  speak  to  a  sick  person  suddenly ;  but,  at  the  same 
time,  do  not  keep  his  expectation  on  the  tiptoe. 

And  to  well.  This  rule,  indeed,  applies  to  the  well  quite  as  much 
as  to  the  sick.  I  have  never  known  persons  who  exposed 
themselves  for  years  to  constant  interruption  who  did  not 
muddle  away  their  intellects  by  it  at  last.  The  process 
with  them  may  be  accomplished  without  pain.  With  the 
sick,  pain  gives  warning  of  the  injury. 

Keeping  a  j)q  j^q^  meet  or  overtake  a  patient  who  is  moving 

standing.  about  in  order  to  speak  to  him,  or  to  give  him  any  mes- 
sage or  letter.  You  might  just  as  well  give  him  a  box 
on  the  ear.  I  have  seen  a  patient  fall  flat  on  the  ground 
who  was  standing  w^hen  his  nurse  came  into  the  room. 
This  was  an  accident  which  might  have  happened  to  the 
most  careful  nurse.     But  the  other  is  done  with  inten- 


NOISE.  51 

tion.  A  patient  in  such  a  state  is  not  going  to  the  East 
Indies.  If  you  would  wait  ten  seconds,  or  walk  ten 
yards  further,  any  promenade  he  could  make  would  be 
over.  You  do  not  know  the  effort  it  is  to  a  patient  to 
remain  standing  for  even  a  quarter  of  a  minute  to  listen 
to  you.  If  I  had  not  seen  the  thing  done  by  the  kindest 
nurses  and  friends,  I  should  have  thought  this  caution 
quite  superfluous.* 

Patients  are  often  accused  of  bein^r  able  to  "  do  much  Patients 

t5  dread  eur- 

more  when  nobody  is  by."  It  is  quite  true  that  they  can.  ?"»«• 
Unless  nurses  can  be  brought  to  attend  to  considerations 
of  the  kind  of  which  we  have  given  here  but  a  few  speci- 
mens, a  very  weak  patient  finds  it  really  much  less  exer- 
tion to  do  things  for  himself  than  to  ask  for  them.  And 
he  will,  in  order  to  do  them,  (very  innocently  and  from  in- 
stinct) calculate  the  time  his  nurse  is  likely  to  be  absent, 
from  a  fear  of  her  "  coming  in  upon  "  him  or  speaking  to 
him,  just  at  the  moment  when  he  finds  it  quite  as  much 
as  he  can  do  to  crawl  from  his  bed  to  his  chair,  or  from 
one  room  to  another,  or  down  stairs,  or  out  of  doors  for 
a  few  minutes.     Some  extra  call  made  upon  his  attention 

*  It  is  absolutely  essential  that  a  nurse  should  lay  this  down  as  Never  speak 
a  positive  rule  to  herself,  never  to  speak  to  any  patient  who  is  }„  theVctof 
standing  or  moving,  as  long  as  she  exercises  so  little  observation  moving, 
as  not  to  know  when  a  patient  cannot  bear  it.     I  am  satisfied  that 
many  of  the  accidents  which  happen  from  feeble  patients  tumb- 
ling down  stairs,  fainting  after    getting  up,  &c,,  happen  solely 
from  the  nurse  popping  out  of  a  door  to  speak  to  the  patient  just 
at  that  moment ;  or  from  his  fearing  that  she  will  do  so.     And 
that  if  the  patient  were  even  left  to  himself,  till  he  can  sit  down, 
such  accidents  would  much  seldomer  occur.     If  the  nurse  accom- 
panies the  patient,  let  her  not  call  upon  him  to  speak.     It  is  in- 
credible that  nurses  cannot  picture  to  themselves  the  strain  upon 
the  heart,  the  lungs,  and  the  brain,  which  the  act  of  moving  is  to 
any  feeble  patient. 


62  XOTES    ox   NUESIXG. 

at  that  moment  will  quite  upset  liim.  In  these  cases 
you  may  be  sure  that  a  patient  in  the  state  we  have  de- 
scribed does  not  make  such  exertions  more  than  once  or 
twice  a  day,  and  probably  much  about  the  same  hour 
every  day.  And  it  is  hard,  indeed,  if  nurse  and  friends 
cannot  calculate  so  as  to  let  him  make  them  undisturbed. 
Eemember,  that  many  patients  can  walk  who  cannot 
stand  or  even  sit  up.  Standing  is,  of  all  positions,  the 
most  trying  to  a  weak  patient. 

Everything  you  do  in  a  patient's  room,  after  he  is 
"  put  up  "  for  the  night,  increases  tenfold  the  risk  of  his 
having  a  bad  night.  But,  if  you  rouse  him  up  after  he 
has  fallen  asleep,  you  do  not  risk,  you  secure  him  a  bad 
night. 

One  hint  I  would  give  to  all  who  attend  or  visit  the 
sick,  to  all  who  have  to  pronounce  an  opinion  upon  sick- 
ness or  its  progress.  Come  back  and  look  at  your  pa- 
tient after  he  has  had  an  hour's  animated  conversation 
with  you.  It  is  the  best  test  of  his  real  state  we  know. 
But  never  pronounce  upon  him  from  merely  seeing  what 
he  does,  or  how  he  looks,  during  such  a  conversation. 
Learn  also  carefully  and  exactly,  if  you  can,  how  he 
passed  the  night  after  it. 

Effects  of  People  rarely,  if  ever,  faint  while  making  an  exertion. 

tk)ri^?n  sick.  It  is  after  it  is  over.  Indeed,  almost  every  effect  of  over- 
exertion appears  after,  not  during  such  exertion.  It  is 
the  highest  folly  to  judge  of  the  sick,  as  is  so  often  done, 
when  you  see  them  merely  during  a  period  of  excitement. 
People  have  very  often  died  of  that  which,  it  has  been 
proclaimed  at  the  time,  has  "  done  them  no  harm."  * 

Careless  ob-  *  As  an  old  experienced  nurse,  I  do  most  earnestly  deprecate 
the  results  of  ^  such  careless  words.  I  have  known  patients  delirious  all  night, 
visft?^  after  seeing   a  visitor  who  called  them  "  better,"  thought  they 


NOISE.  53 

Eemember  never  to  lean  against,  sit  upon,  or  unne- 
cessarily shake,  or  even  touch  the  bed  in  which  a  patient 
lies.  This  is  invariably  a  painful  annoyance.  If  you 
shake  the  chair  on  which  he  sits,  he  has  a  point  by  which 
to  steady  himself,  in  his  feet.  But  on  a  bed  or  sofa,  he 
is  entirely  at  your  mercy,  and  he  feels  every  jar  you  give 
him  all  through  him. 

In  all  that  we  have  said,  both  here  and  elsewhere,  let  ^jJ^^^J*^^^ 
it  be  distinctly  understood  that  we  are  not  speaking  of  ^^^Jj^^J^^^ 
hypochondriacs.  To  distinguish  between  real  and  fan- 
cied disease  forms  an  important  branch  of  the  education 
of  a  nurse.  To  manage  fancy  patients  forms  an  impor- 
tant branch  of  her  duties.  But  the  nursing  which  real 
and  that  which  fancied  patients  require  is  of  different,  or 
rather  of  opposite,  character.  And  the  latter  will  not  be 
spoken  of  here.  Indeed,  many  of  the  symptoms  which 
are  here  mentioned  are  those  which  distinguish  real  from 
fancied  disease. 

It  is  true  that  hypochondriacs  very  often  do  that  be- 
hind a  nurse's  back  which  they  would  not  do  before  her 
face.  Many  such  I  have  had  as  patients  who  scarcely 
ate  anything  at  their  regular  meals  ;  but  if  you  concealed 

"  only  wanted  a  little  amusement,"  and  who  came  again,  saying, 
"  I  hope  you  were  not  the  worse  for  my  visit,"  neither  waiting  for 
an  answer,  nor  even  looking  at  the  case.  No  real  patient  will 
ever  say,  "  Yes,  but  I  was  a  great  deal  the  worse." 

It  is  not,  however,  either  death  or  dehrium  of  which,  in  these 
cases,  there  is  most  danger  to  the  patient.  Unperceived  conse- 
quences are  far  more  Ukcly  to  ensue.  You  will  have  impunity — 
the  poor  patient  will  not.  That  is,  the  patient  will  suffer,  although 
neither  he  nor  the  inflictor  of  the  injury  will  attribute  it  to  its  real 
cause.  It  will  not  be  directly  traceable,  except  by  a  very  careful 
observant  nurse.  The  patient  will  often  not  even  mention  what 
has  done  him  most  harm. 


54  NOTES    ON   NUKSING. 

food  for  them  in  a  drawer,  they  would  take  it  at  night  or 
in  secret.  But  this  is  from  quite  a  diflferent  motive. 
They  do  it  from  the  wish  to  conceal.  Whereas  the  real 
patient  will  often  boast  to  his  nurse  or  doctor,  if  these  do 
not  shake  their  heads  at  him,  of  how  much  he  has  done, 
or  eaten,  or  walked.  To  return  to  real  disease. 
Conciseness  Conciseness  and  decision  are,  above  all  thinrjs,  neces- 

with  sick,  sary  with  the  sick.  Let  your  thought  expressed  to  them 
be  concisely  and  decidedly  expressed.  What  doubt  and 
hesitation  there  may  be  in  your  own  mind  must  never  be 
communicated  to  theirs,  not  even  (I  would  rather  say  es- 
pecially not)  in  little  things.  Let  your  doubt  be  to  your- 
self, your  decision  to  them.  People  who  think  outside 
their  heads,  the  whole  process  of  whose  thought  appears, 
like  Homer's,  in  the  act  of  secretion,  who  tell  everything 
that  led  them  towards  this  conclusion  and  away  from 
that,  ought  never  to  be  with  the  sick. 
Irresolution         Irresolution  is  what  all  patients  most  dread.    Eather 

most  painful  ^     ^  -^  _ 

to  them.  than  meet  this  in  others,  they  will  collect  all  their  data, 
and  make  up  their  minds  for  themselves.  A  change  of 
mind  in  others,  whether  it  is  regarding  an  operation,  or 
re-writing  a  letter,  always  injures  the  patient  more  than 
the  being  called  upon  to  make  up  his  mind  to  the  most 
dreaded  or  difficult  decision.  Farther  than  this,  in  very 
many  cases,  the  imagination  in  disease  is  far  more  active 
and  vivid  than  it  is  in  health.  If  you  propose  to  the 
patient  change  of  air  to  one  place  one  hour,  and  to  an- 
other the  next,  he  has,  in  each  case,  immediately  consti- 
tuted himself  in  imagination  the  tenant  of  the  place, 
gone  over  the  whole  premises  in  idea,  and  you  have  tired 
him  as  much  by  displacing  his  imagination,  as  if  you  had 
actually  carried  him  over  both  places. 

Above  all,  leave  the  sick  room  quickly  and  come  into 


NOISE.  55 

it  quickly,  not  suddenly,  not  with  a  rush.  But  don't  let 
the  patient  be  wearily  waiting  for  when  you  will  be  out 
of  the  room  or  when  you  will  be  in  it.  Conciseness  and 
decision  in  your  movements,  as  well  as  your  words,  are 
necessary  in  the  sick  room,  as  necessary  as  absence  of 
hurry  and  bustle.  To  possess  yourself  entirely  will  en- 
sure you  from  either  failing — either  loitering  or  hurry, 
ing. 

If  a  patient  has  to  see,  not  only  to  his  own  but  also  JJ^^f  jj  PjJ' 
to  his  nurse's  punctuality,  or  perseverance,  or  readiness,  °ot  have  t« 
or  calmness,  to  any  or  all  of  these  things,  he  is  far  better 
without  that  nurse  than  with  her — however  valuable  and 
handy  her  services  may  otherwise  be  to  him,  and  how- 
ever incapable  he  may  be  of  rendering  them  to  himself. 

With  regard  to  reading  aloud  in  the  sick  room,  my  Reading 

•        1  1  1         •   1  '11  1  aloud. 

experience  is,  that  when  the  sick  are  too  ill  to  read  to 
themselves,  they  can  seldom  bear  to  be  read  to.  Chil- 
dren, eye-patients,  and  uneducated  persons  are  excep- 
tions, or  where  there  is  any  mechanical  difficulty  in  read- 
ing. People  who  like  to  be  read  to,  have  generally  not 
much  the  matter  with  them ;  while  in  fevers,  or  where 
there  is  much  irritability  of  brain,  the  effort  of  listening 
to  reading  aloud  has  often  brought  on  delirium.  I  speak 
with  great  diffidence  ;  because  there  is  an  almost  univer- 
sal impression  that  it  is  sparing  the  sick  to  read  aloud  to 
them.     But  two  things  are  certain : — 

(1.)  If  there  is  some  matter  which  must  be  read  to  a  Read  aloud 
sick  person,  do  it  slowly.     People  often  think  that  the  tinctiy,  and 
way  to  get  it  over  with  least  fatigue  to  him  is  to  get  it  thc^si'ck.  ** 
over  in  least  time.     They  gabble  ;  they  plunge  and  gal- 
lop through  the  reading.    There  never  was  a  greater  mis- 
take.    Houdin,  the  conjuror,  says  that  the  way  to  make 
a  story  seem  short  is  to  tell  it  slowly.     So  it  is  with  read- 


66  NOTES    ON    NUESING. 

ing  to  the  sick.  I  have  often  heard  a  patient  say  to  such 
a  mistaken  reader,  "  Don't  read  it  to  me  ;  tell  it  me."  * 
Unconsciously  he  is  aware  that  this  will  regulate  the 
plunging,  the  reading  with  unequal  paces,  slurring  over 
one  part,  instead  of  leaving  it  out  altogether,  if  it  is  un- 
important, and  mumbling  another.  If  the  reader  lets 
his  own  attention  wander,  and  then  stops  to  read  up  to 
himself,  or  finds  he  has  read  the  wrong  bit,  then  it 
is  all  over  with  the  poor  patient's  chance  of  not  suffering. 
Very  few  people  know  how  to  read  to  the  sick ;  very 
few  read  aloud  as  pleasantly  even  as  they  speak.  In 
reading  they  sing,  they  hesitate,  they  stammer,  they 
hurry,  they  mumble ;  when  in  speaking  they  do  none 
of  these  things.  Reading  aloud  to  the  sick  ought  always 
to  be  rather  slow,  and  exceedingly  distinct,  but  not  mouth- 
ing— rather  monotonous,  but  not  sing  song — rather  loud 
but  not  noisy — and,  above  all,  not  too  long.  Be  very 
sure  of  w^hat  your  patient  can  bear. 
Never  read  (2.)  The  extraordinary  habit  of  readine^  to  oneself  in 

aloud  by  fits  .\    '  ,  tit  i  •  i  • 

and  starts  to  a  sick  room,  and  reading  aloud  to  the  patient  any  bits 
which  will  amuse  him  or  more  often  the  reader,  is  unac- 
countably thoughtless.  What  do  you  think  the  patient 
is  thinking  of  during  your  gaps  of  non-reading  ?  Do  you 
think  that  he  amuses  himself  upon  what  you  have  read 
for  precisely  the  time  it  pleases  you  to  go  on  reading  to 
yourself,  and  that  his  attention  is  ready  for  something 
else  at  precisely  the  time  it  pleases  you  to  begin  reading 
again  ?  Whether  the  person  thus  read  to  be  sick  or 
well,  whether  he  be  doing  nothing  or  doing  something 
else  while  being  thus  read  to,  the  self-absorption  and 

TheBick  *  Sick  children,  if  not  too  shy  to  speak,  will  always  express 

be^'tiw  a*^"  this  wish.     They  invariably  prefer  a  story  to  be  told  to  them, 

thing  than      rather  than  read  to  them, 
have  it  read 
to  them. 


NOISE.  5  7 

want  of  observation  of  the  person  who  does  it,  is  equally 
difficult  to  understand — although  very  often  the  readce 
is  too  amiable  to  say  how  much  it  hurts  him. 

One  thing  more  : — From  the  flimsy  manner  in  which  People  over, 
most  modern  houses  are  built,  where  every  step  on  the 
stairs,  and  along  the  floors,  is  felt  all  over  the  house ;  the 
higher  the  story,  the  greater  the  vibration.  It  is  incon- 
ceivable how  much  the  sick  suffer  by  having  anybody 
overhead.  In  the  solidly  built  old  houses,  which,  for- 
tunately, most  hospitals  are,  the  noise  and  shaking  is 
comparatively  trifling.  But  it  is  a  serious  cause  of  suf- 
fering, in  lightly  built  houses,  and  with  the  irritability 
peculiar  to  some  diseases.  Better  far  put  such  patients 
at  the  top  of  the  house,  even  with  the  additional  fatigue 
of  stairs,  if  you  cannot  secure  the  room  above  them  being 
untenanted ;  you  may  otherwise  bring  on  a  state  of  rest- 
lessness which  no  opium  will  subdue.  Do  not  neglect 
the  warning,  when  a  patient  tells  you  that  he  "  Feels 
every  step  above  him  to  cross  his  heart."  Eemember 
that  every  noise  a  patient  cannot  see  partakes  of  the 
character  of  suddenness  to  him ;  and  I  am  persuaded 
that  patients  with  these  peculiarly  irritable  nerves,  are 
positively  less  injured  by  having  persons  in  the  same 
room  with  them  than  overhead,  or  separated  by  only  a 
thin  compartment.  Any  sacrifice  to  secure  silence  for 
these  cases  is  worth  while,  because  no  air,  however  good, 
no  attendance,  however  careful,  will  do  anything  for 
such  cases  without  quiet. 

Note. — The  effect  of  music  upon  the  sick  has  been  scarcely  at  Mufilo 
all  noticed.  In  fact,  its  expensivcness,  as  it  is  now,  makes  any- 
general  application  of  it  quite  out  of  the  question.  I  will  only 
remark  here,  that  wind  instruments,  including  the  human  voice, 
and  stringed  instrument?,  capable  of  continuous  sound,  have  gcn- 
3* 


58  NOTES    OX   NURSING. 

erally  a  beneficent  effect — while  the  piano-forte,  with  such  instru- 
ments as  have  no  continuity  of  sound,  has  just  the  reverse.  The 
finest  piano-forte  playing  will  damage  the  sick,  while  an  air,  like 
*'  Home,  sweet  home,"  or  "  Assisa  a  pie  d'un  salice,"  on  the  most 
ordinary  grinding  organ,  will  sensibly  soothe  them — and  this  quite 
independent  of  association. 


V.  VARIETY. 

Variety  a  To  any  but  an  old  nurse,  or  an  old  patient,  tlie  de- 

means of  re-  .      .  .11  1-11  f 

covery.         gree  would  be  quite  inconceivable  to  which  the  nerves  oi 

the    sick  suffer  from  seeing  the   same  walls,  the  same 

ceiling,  the  same  surroundings  during  a  long  confinement 

to  one  or  two  rooms. 

The  superior  cheerfulness  of  persons  suffering  severe 
paroxysms  of  pain  over  that  of  persons  suffering  from 
nervous  debility  has  often  been  remarked  upon,  and 
attributed  to  the  enjoyment  of  the  former  of  their  inter- 
vals of  respite.  I  incline  to  think  that  the  majority  of 
cheerful  cases  is  to  be  found  among  those  patients  who 
are  not  confined  to  one  room,  whatever  their  suffering, 
and  that  the  majority  of  depressed  cases  will  be  seen 
among  those  subjected  to  a  long  monotony  of  objects 
about  them. 

The  nervous  frame  really  suffers  as  much  from  this  as 

the  digestive  organs  from  long  monotony  of  diet,  as  e.g. 

the  soldier  from  his  twenty-one  years'  "  boiled  beef." 

Colour  and  The  effect  in  sickness  of  beautiful  objects,  of  variety 

»f  recovery,  of  objects,  and  especially  of  brilliancy  of  colour  is  hardly 

at  all  appreciated. 

Such  cravings  are  usually  called  the  "fancies"  of 
patients.  And  often  doubtless  patients  have  "  fancies," 
as  e.g.  when  they  desire  two  contradictions.  But  much 
more  often,  their  (so  called)  "  fancies  "  are  the  most  va- 


VARIETY.  59 

luable  indications  of  what  is  necessary  for  their  recovery. 
And  it  would  be  well  if  nurses  would  watch  these  (so 
called)  "  fancies  "  closely. 

I  have  seen,  in  fevers  (and  felt,  when  I  was  a  fever 
patient  myself),  the  most  acute  suffering  produced  from 
the  patient  (in  a  hut)  not  being  able  to  see  out  of  window, 
and  the  knots  in  the  wood  being  the  only  view.  I  shall 
never  forget  the  rapture  of  fever  patients  over  a  bunch  of 
bright-coloured  flowers.  I  remember  (in  my  own  case) 
a  nosegay  of  wild  flowers  being  sent  me,  and  from  that 
moment  recovery  becoming  more  rapid. 

People  say  the  eflfect  is  only  on  the  mind.     It  is  no  ™y3  °« 
such  thing.     The  effect  is  on  the  body,  too.     Little  as 
we  know  about  the  way  in  which  we  are  affected  by  form, 
by  colour,  and  light,  we  do  know  this,  that  they  have  an 
actual  physical  effect. 

Variety  of  form  and  brilliancy  of  colour  in  the  objects 
presented  to  patients  are  actual  means  of  recovery. 

But  it  must  be  slow  variety,  e.g.,  if  you  shew  a  patient 
ten  or  twelve  engravings  successively,  ten-to-one  that 
he  does  not  become  cold  and  faint,  or  feverish,  or  even 
sick  ;  but  hang  one  up  opposite  him,  one  on  each  succes- 
sive day,  or  week,  or  month,  and  he  will  revel  in  the 
variety. 

The  folly  and  ignorance  which  reign  too  often  su-  Flowers, 
preme  over  the  sick-room,  cannot  be  better  exemplified 
than  by  this.  While  the  nurse  will  leave  the  patient 
stewing  in  a  corrupting  atmosphere,  the  best  ingredient 
of  which  is  carbonic  acid  ;  she  will  deny  him,  on  the 
plea  of  unhealthiness,  a  glass  of  cut-flowers,  or  a  growing 
plant.  Now,  no  one  ever  saw  "  overcrowding  "  by  plants 
in  a  room  or  ward.  And  the  carbonic  acid  they  give  oflf 
at  nights  would  not  poison  a  fly.     Nay,  in  overcrowded 


60 


NOTES    ON   NURSING. 


Effect  of 
bod}'  on 
mind. 


rooms,  they  actually  absorb  carbonic  acid  and  give  off 
oxygen.  Cut-flowers  also  decompose  water  and  produce 
oxygen  gas.  It  is  true  there  are  certain  flowers,  e.g., 
lilies,  the  smell  of  which  is  said  to  depress  the  nervous 
system.  These  are  easily  known  by  the  smell,  and  can 
be  avoided. 

Volumes  are  now  written  and  spoken  upon  the  effect 
of  the  mind  upon  the  body.  Much  of  it  is  true.  But  I 
wish  a  little  more  was  thought  of  the  effect  of  the  body  on 
the  mind.  You  who  believe  yourselves  overwhelmed 
with  anxieties,  but  are  able  every  day  to  walk  up  Eegent- 
street,  or  out  in  the  country,  to  take  your  meals  with 
others  in  other  rooms,  &c.,  &c.,  you  little  know  how  much 
your  anxieties  are  thereby  lightened ;  you  little  know 
how  intensified  they  become  to  those  who  can  have  no 
change  ;*  how  the  very  walls  of  their  sick  rooms  seem 
hung  with  their  cares ;  how  the  ghosts  of  their  troubles 
haunt  their  beds;  how  impossible  it  is  for  them  to 
escape  from  a  pursuing  thought  without  some  help  from 
variety. 

A  patient  can  just  as  much  move  his  leg  when  it  is 
fractured  as  change  his  thoughts  when  no  external  help 


Sick  suffer  *  It  is  a  matter  of  painful  wonder  to  the  sick  themselves,  how 

from  nTental  ^^ch  painful  ideas  predominate  over  pleasurable  ones  in  their 
as  well  as  impressions  ;  they  reason  with  themselves  ;  they  think  themselves 
ungrateful ;  it  is  all  of  no  use.  The  fact  is,  that  these  painful 
impressions  are  far  better  dismissed  by  a  real  laugh,  if  you  can 
excite  one  by  books  or  conversation,  than  by  any  direct  reason- 
ing ;  or  if  the  patient  is  too  weak  to  laugh,  some  impression  from 
nature  is  what  he  wants.  I  have  mentioned  the  cruelty  of  let- 
ting him  stare  at  a  dead  wall.  In  many  diseases,  especially  in 
convalescence  from  fever,  that  wall  will  appear  to  make  all  sorts 
of  faces  at  him  ;  now  flowers  never  do  this.  Form,  colour,  will 
free  your  patient  from  his  painful  ideas  better  than  any  argument. 


VARIETY.  61 

from  variety  is  given  him.  This  is,  indeed,  one  of  the 
main  sufferings  of  sickness  ;  just  as  the  fixed  posture  is 
one  of  the  main  sufferings  of  the  broken  limb. 

It  is  an  ever  recurring  wonder  to  see  educated  people,  ^eip  the 

^  ^  •"•      ^     '  sick  toviiry 

who  call   themselves  nurses,  acting  thus.      They  vary  their 

'  ^  .  thoughts. 

their  own  objects,  their  own  employments,  many  times  a 
day;  and  while  nursing  (!)  some  bed-ridden  sufferer, 
they  let  him  lie  there  staring  at  a  dead  wall,  without  any 
change  of  object  to  enable  him  to  vary  his  thoughts  ;  and 
it  never  even  occurs  to  them,  at  least  to  move  his  bed  so 
that  he  can  look  out  of  window.  No,  the  bed  is  to  be 
always  left  in  the  darkest,  dullest,  remotest,  part  of  the 
room.* 

I  think  it  is  a  very  common  error  among  the  well  to 
think  that  "  with  a  little  more  self-control "  the  sick 
might,  if  they  choose,  "  dismiss  painful  thoughts  "  which 
"  aggravate  their  disease,"  (fee.     Believe  me,  almost  a?ii/ 


*  I  remember  a  case  in  point.  A  man  received  an  injury  to  Desperate 
the  spine,  from  an  accident,  which  after  a  long  confinement  ended  gick  to  "  set* 
in  death.  He  was  a  workman — had  not  in  his  composition  a  ^"*y^,f  "^^^'^' 
single  grain  of  what  is  called  "enthusiasm  for  nature" — but  he 
was  desperate  to  "  see  once  more  out  of  window."  His  nurse 
actually  got  him  on  her  back,  and  managed  to  perch  him  up  at 
the  window  for  an  instant,  *'  to  see  out."  The  consequence  to  the 
poor  nurse  was  a  serious  illness,  which  nearly  proved  fatal.  The 
man  never  knew  it ;  but  a  great  many  other  people  did.  Yet  the 
consequence  in  none  of  their  minds,  so  far  as  I  know,  was  the 
conviction  that  the  craving  for  variety  in  the  starving  eye,  is  just 
as  desperate  as  that  of  food  in  the  starving  stomach,  and  tempts 
the  famishing  creature  in  either  case  to  steal  for  its  satisfaction. 
Xo  other  word  will  express  it  but  "  desperation."  And  it  sets 
the  seal  of  ignorance  and  stupidity  just  as  much  on  the  governors 
and  attendants  of  the  sick  if  they  do  not  provide  the  sick-bed 
with  a  "view"  of  some  kind,  as  if  they  did  not  provide  the  hos- 
pital with  a  kitchen. 


62 


NOTES    ON   NUESING. 


Supply  to 
the  sick  the 
defect  of 
manual  la- 
bour. 


sick  person,  who  behaves  decently  well,  exercises  more 
self-control  every  moment  of  his  day  than  you  will  ever 
know  till  you  are  sick  yourself.  Almost  every  step  that 
crosses  his  room  is  painful  to  him  ;  almost  every  thought 
that  crosses  his  brain  is  painful  to  him :  and  if  he  can 
speak  without  being  savage,  and  look  without  being  un- 
pleasant, he  is  exercising  self-control. 

Suppose  you  have  been  up  all  night,  and  instead  of 
being  allowed  to  have  your  cup  of  tea,  you  were  to  be  told 
that  you  ought  to  "  exercise  self-control,"  what  should 
you  say  ?  Now,  the  nerves  of  the  sick  are  always  in  the 
state  that  yours  are  in  after  you  have  been  up  all  night. 

We  will  suppose  the  diet  of  the  sick  to  be  cared  for. 
Then,  this  state  of  nerves  is  most  frequently  to  be  re- 
lieved by  care  in  aflfording  them  a  pleasant  view,  a 
judicious  variety  as  to  flowers,*  and  pretty  things. 
Light  by  itself  will  often  relieve  it.  The  craving  for 
"the  return  of  day,"  which  the  sick  so  constantly  evince, 
is  generally  nothing  but  the  desire  for  light,  the  remem- 
brance of  the  relief  which  a  variety  of  objects  before  the 
eye  affords  to  the  harassed  sick  mind. 

Again,  every  man  and  every  woman  has  some  amount 
of  manual  employment,  excepting  a  few  fine  ladies,  who 
do  not  even  dress  themselves,  and  who  are  virtually  in 
the  same  category,  as  to  nerves,  as  the  sick.  Now,  you 
can  have  no  idea  of  the  relief  which  manual  labour  is  to 
you — of  the  degree  to  which  the  deprivation  of  manual 
employment  increases  the  peculiar  irritability  from  which 
many  sick  suffer. 


A  little  needle-work,  a  little  writin; 


ittle  clean- 


Physical 
effect  of 
colour. 


*  Xo  one  Avho  has  watched  the  sick  can  doubt  the  fact,  that 
some  feel  stimulus  from  looking  at  scarlet  flowers,  exhaustion 
from  looking  at  deep  blue,  &c. 


TAKING   FOOD.  63 

ing,  would  be  the  greatest  relief  the  sick  could  have,  if 
they  could  do  it ;  these  are  the  greatest  relief  to  you, 
though  you  do  not  know  it.  Eeading,  though  it  is  often 
the  only  thing  the  sick  can  do,  is  not  this  relief.  Bear- 
ing this  in  mind,  bearing  in  mind  that  you  have  all  these 
varieties  of  employment  which  the  sick  cannot  have,  bear 
also  in  mind  to  obtain  for  them  all  the  varieties  which 
they  can  enjoy. 

I  need  hardly  say  that  I  am  well  aware  that  excess 
in  needle-work,  in  writing,  in  any  other  continuous  em- 
plo}Tnent,  will  produce  the  same  irritability  that  defect 
in  manual  employment  (as  one  cause)  produces  in  the 
sick. 

YI.  TAKIXG  FOOD. 
Every  careful  observer  of  the  sick  will  ao^ree  in  this  Y^Y^  ^t*^' 

•^  "  tention  to 

that  thousands  of  patients  are   annually  starved  in  the  ^o^p  ^l}^^' 

midst  of  plenty,   from  want  of  attention  to   the  ways 

which  alone  make  it  possible  for  them  to  take  food.    This 

want  of  attention  is   as  remarkable  in  those  who  urge 

upon  the  sick  to  do  what  is  quite  impossible  to  them,  as 

in  the  sick  themselves  who  will  not  make  the  effort  to  do 

Avhat  is  perfectly  possible  to  them. 

For  instance,  to  the  large  majority  of  very  weak  pa- 
tients it  is  quite  impossible  to  take  any  solid  food  before 
11  A.M.,  nor  then,  if  their  strength  is  still  further  ex- 
hausted by  fasting  till  that  hour.  For  weak  patients 
have  generally  feverish  nights  and,  in  the  morning,  dry 
mouths ;  and,  if  they  could  eat  with  those  dry  mouths, 
it  would  be  the  worse  for  them.  A  spoonful  of  beef-tea, 
of  arrowroot  and  wine,  of  ^^^  flip,  every  hour,  will  give 
them  the  requisite  nourishment,  and  prevent  them  from 


64  NOTES    ON   NURSING. 

being  too  mucli  exhausted  to  take  at  a  later  hour  the 
solid  food,  which  is  necessary  for  their  recovery.  And 
every  patient  who  can  swallow  at  all  can  swallow  these 
liquid  things,  if  he  chooses.  But  how  often  do  we  hear 
a  mutton-chop,  an  egg,  a  bit  of  bacon,  ordered  to  a  pa- 
tient for  breakfast,  to  whom  (as  a  moment's  consideration 
would  show  us)  it  must  be  quite  impossible  to  masticate 
such  things  at  that  hour. 

Again,  a  nurse  is  ordered  to  give  a  patient  a  tea-cup 
full  of  some  article  of  food  every  three  hours.  The  pa- 
tient's stomach  rejects  it.  If  so,  try  a  table-spoon  full 
every  hour ;  if  this  will  not  do,  a  tea-spoon  full  every 
quarter  of  an  hour. 

I  am  bound  to   say,  that  I  think  more  patients  are 

lost  by  want  of  care  and  ingenuity  in  these  momentous 

minuticB   in   private   nursing  than  in   public  hospitals. 

And  I  think  there  is  more  of  the  entente  cor di ale  to  assist 

one  another's  hands  between  the  doctor  and  his  head 

nurse  in  the  latter  institutions,  than  between  the  doctor 

and  the  patient's  friends  in  the  private  house. 

Life  often  If  we  did  but  know  the  consequences  which  may  en- 

bangs  upon 
minutes  in    suc,  in  very  weak  patients,  from  ten  minutes'  fastins:  or 

taking  food.  *^  ^  .  , 

repletion  (I  call  it  repletion  when  they  are  obliged  to  let 
too  small  an  interval  elapse  between  taking  food  and  some 
other  exertion,  owing  to  the  nurse's  unpunctuality),  we 
should  be  more  careful  never  to  let  this  occur.  In  very 
weak  patients  there  is  often  a  nervous  difficulty  of  swal- 
lowing, which  is  so  much  increased  by  any  other  call 
upon  their  strength  that,  unless  they  have  their  food 
punctually  at  the  minute,  which  minute  again  must  be 
arranged  so  as  to  fall  in  with  no  other  minute's  occupa- 
tion, they  can  take  nothing  till  the  next  respite  occurs 
— so  that  an  unpunctuality  or  delay  of  ten  minutes  may 


TAKING   FOOD.  65 

very  well  turn  out  to  be  one  of  two  or  three  hours.  And 
why  is  it  not  as  easy  to  be  punctual  to  a  minute  1  Life 
often  literally  hangs  upon  these  minutes. 

In  acute  cases,  where  life  or  death  is  to  be  determined 
in  a  few  hours,  these  matters  are  very  generally  attended 
to,  especially  in  Hospitals ;  and  the  number  of  cases  is 
large  where  the  patient  is,  as  it  were,  brought  back  to 
life  by  exceeding  care  on  the  part  of  the  Doctor  or  Nurse, 
or  both,  in  ordering  and  giving  nourishment  with  minute 
selection  and  punctuality. 

But  in  chronic  cases,  lastins^  over  months  and  yea/S,  Patients  of- 

^  o  J  7  ^Qj^  Starved 

where  the  fatal  issue  is  often  determined  at  last  by  mere  to  death  in 

•'  cnronio 

protracted  starvation,  I  had  rather  not  enumerate  the  cases. 
instances  which  I  have  known  where  a  little  ingenu- 
ity, and  a  great  deal  of  perseverance,  might,  in  all 
probability,  have  averted  the  result.  The  consulting  the 
hours  when  the  patient  can  take  food,  the  observation  of 
the  times,  often  varying,  when  he  is  most  faint,  the  alter- 
ing seasons  of  taking  food,  in  order  to  anticipate  and 
prevent  such  times — all  this,  which  requires  observation, 
ingenuity,  and  perseverance  (and  these  really  constitute 
the  good  Nurse),  might  save  more  lives  than  we  wot  of. 

To  leave  the  patient's  untasted  food  by  his  side,  from  fj'^^g^iJft'" 
meal  to  meal,  in  hopes  that  he  will  eat  it  in  the  interval  ^7  the  pa- 

'  ^  ^  tient's  side. 

is  simply  to  prevent  him  from  taking  any  food  at  all.  I 
have  known  patients  literally  incapacitated  from  taking 
one  article  of  food  after  another,  by  this  piece  of  ignorance. 
Let  the  food  come  at  the  right  time,  and  be  taken  away, 
eaten  or  uneaten,  at  the  right  time ;  but  never  let  a 
patient  have  "something  always  standing"  by  him,  if 
you  don't  wish  to  disgust  him  of  everything. 

On  the  other  hand,  I  have  known  a  patient's  life 
saved  (he  was  sinking  for  want  of  food)  by  the  simple 


Patient  had 
better  not 


66  NOTES    OX   NURSING. 

question,  put  to  liim  by  the  doctor,  "  But  is  there  no 
hour  ^vhen  jou  feel  you  could  eat  ?"  "  Oh,  yes,"  he  said, 
"  I  could  always  take  something  at  —  o'clock  and  — 
o'clock."  The  thing  was  tried  and  succeeded.  Patients 
very  seldom,  however,  can  tell  this ;  it  is  for  you  to 
watch  and  find  it  out. 

A  patient  should,  if  possible,  not  see  or  smell  either 

foocrSarThis  ^^®  ^^^^  ^^  others,  or  a  greater  amount  of  food  than  he 

o'"'^-  himself  can  consume  at   one   time,  or    even  hear  food 

talked  about  or  see  it  in  the  raw  state.     I  know  of  no 

exception  to  the  above  rule.     The  breaking  of  it  always 

induces  a  greater  or  less  incapacity  of  taking  food. 

In  hospital  w^  ards  it  is  of  course  impossible  to  observe 
all  this  ;  and  in  single  wards,  where  a  patient  must  be 
continuously  and  closely  watched,  it  is  frequently  im- 
possible to  relieve  the  attendant,  so  that  his  or  her  own 
meals  can  be  taken  out  of  the  ward.  But  it  is  not  the 
less  true  that,  in  such  cases,  even  where  the  patient  is  not 
himself  aware  of  it,  his  possibility  of  taking  food  is  limit- 
ed by  seeing  the  attendant  eating  meals  under  his  ob- 
servation. In  some  cases  the  sick  are  aware  of  it,  and 
complain,  A  case  ^vhere  the  patient  ^vas  supposed  to  be 
insensible,  but  complained  as  soon  as  able  to  speak,  is 
now  present  to  my  recollection. 

Remember,  however,  that  the  extreme  punctuality  in 
well-ordered  hospitals,  the  rule  that  nothing  shall  be  done 
in  the  ward  while  the  patients  are  having  their  meals,  go 
far  to  counterbalance  what  unavoidable  evil  there  is  in 
having  patients  together.  I  have  often  seen  the  private 
nurse  go  on  dusting  or  fidgeting  about  in  a  sick  room  all 
the  while  the  patient  is  eating,  or  trying  to  eat. 

That  the  more  alone  an  invalid  can  be  when  taking 
food,  the  better,  is  unquestionable ;  and,  even  if  he  must 


TAKING   FOOD.  67 

be  fed,  the  nurse  should  not  allow  him  to  talk,  or  talk  to 
him,  especially  about  food,  while  eating. 

When  a  person  is  compelled,  by  the  pressure  of  occu- 
pation, to  continue  his  business  while  sick,  it  ought  to  be 
a  rule  WITHOUT  any  exception  whatever,  that  no  one 
shall  bring  business  to  him  or  talk  to  him  while  he  is 
taking  food,  nor  go  on  talking  to  him  on  interesting  sub- 
jects up  to  the  last  moment  before  his  meals,  nor  make 
an  engagement  with  him  immediately  after,  so  that  there 
be  any  hurry  of  mind  while  taking  them. 

Upon  the  observance  of  these  rules,  especially  the  first, 
often  depends  the  patient's  capability  of  taking  food  at  all, 
or,  if  he  is  amiable  and  forces  himself  to  take  food,  of 
deriving  any  nourishment  from  it. 

A  nurse  should  never  put  before  a  patient  milk  that  You  cannot 

.  be  too  cate- 

is  sour,  meat  or  soup  that  is  turned,  an  eo^ar  that  is  bad,  fui  as  to 

'  ^  J  o&  J  quality  in 

or  vegetables  underdone.  Yet  often  I  have  seen  these  sick  diet, 
things  brought  in  to  the  sick  in  a  state  perfectly  percep- 
tible to  every  nose  or  eye  except  the  nurse's.  It  is  here 
that  the  clever  nurse  appears ;  she  will  not  bring  in  the 
peccant  article,  but,  not  to  disappoint  the  patient,  she 
will  whip  up  something  else  in  a  few  minutes.  Remem- 
ber that  sick  cookery  should  half  do  the  work  of  your 
poor  patient's  weak  digestion.  But  if  you  further  impair 
it  with  your  bad  articles,  I  know  not  what  is  to  become 
of  him  or  of  it. 

If  the  nurse  is  an  intelligent  being,  and  not  a  mere 
carrier  of  diets  to  and  from  the  patient,  let  her  exercise 
her  intelligence  in  these  things.  How  often  we  have 
known  a  patient  eat  nothing  at  all  in  the  day,  because 
one  meal  was  left  untasted  (at  that  time  he  was  incapable 
of  eating),  at  another  the  milk  was  sour,  the  third  was 
spoiled  by  some  other  accident.     And  it  never  occurred 


68  NOTES    ON   NUBSING. 

to  the  nurse  to  extemporize  some  expedient, — it  never 
occurred  to  her  that  as  he  had  had  no  solid  food  that  day- 
he  might  eat  a  Lit  of  toast  (say)  with  his  tea  in  the  even- 
ing, or  he  might  have  some  meal  an  hour  earlier.  A 
patient  who  cannot  touch  his  dinner  at  two,  will  often 
accept  it  gladly,  if  brought  to  him  at  seven.  But  some- 
how nurses  never  "  think  of  these  things."  One  would 
imagine  they  did  not  consider  themselves  bound  to  exer- 
cise their  judgment ;  they  leave  it  to  the  patient.  Now 
I  am  quite  sure  that  it  is  better  for  a  patient  rather  to 
suffer  these  neglects  than  to  try  to  teach  his  nurse  to 
nurse  him,  if  she  does  not  know  how.  It  ruffles  him,  and 
if  he  is  ill  he  is  in  no  cond  ition  to  teach,  especially  upon 
himself.  The  above  remarks  apply  much  more  to  pri- 
vate nursing  than  to  hospitals. 
Nurse  must         I  would  sav  to  the  nursc,  have  a  rule  of  thouo^ht 

have  some  "^  ° 

rule  of  about  your  patient's  diet ;  consider,  remember  how  much 

about  her      he  has  had,  and   how  much  he  ought  to  have  to-day. 

patient's 

diet.  Generally,  the  only  rule  of  the  private  patient's  diet  is 

what  the  nurse  has  to  give.     It  is  true  she  cannot  give 
him  what  she  has  not  got ;  but  his  stomach  does  not 
wait  for  her  convenience,  or  even  her  necessity.*     If  it  is 
used  to  having  its  stimulus  at  one  hour  to-day,  and  to- 
morrow it  does  not  have  it,  because  she  has  failed  in  get- 
Nurse  must         *  Why,  because  the  nurse  has  not  got  some  food  to-day  which 
rule  of  time   the  patient  takes,  can  the  patient  wait  four  hours  for  food  to-day, 
about  the       ^.|^q  could  not  wait  two  hours  yesterday  ?     Yet  this  is  the  only 

pUtlGIlt  S 

diet.  logic  one  generally  hears.     On  the  other  hand,  the  other  logic, 

viz.,  of  the  nurse  giving  a  patient  a  thing  because  she  has  got  it, 
is  equally  fatal.  If  she  happens  to  have  fresh  jelly,  ©r  fresh  fruit, 
she  will  frequently  give  it  to  the  patient  half  an  hour  after  his 
dinner,  or  at  his  dinner,  when  he  cannot  possibly  eat  that  and  the 
broth  too — or  worse  still,  leave  it  by  his  bed-side  till  he  is  so  sick- 
ened with  the  sight  of  it,  that  he  cannot  eat  it  at  all. 


WHAT  FOOD  ':*  69 

ting  it,  he  will  suffer.  She  must  be  always  exercising 
her  ingenuity  to  supply  defects,  and  to  remedy  accidents 
which  will  happen  among  the  best  contrivers,  but  from 
which  the  patient  does  not  suffer  the  less,  because  "  they 
cannot  be  helped." 

One  very  minute  caution, — take  care  not  to  spill  into  Sk?nfs"un 
your  patient's  saucer,  in  other  words,  take  care  that  the  out-  neath"'^*^'^" 
side  bottom  rim  of  his  cup  shall  be  quite  dry  and  clean  ;  if, 
every  time  he  lifts  his  cup  to  his  lips,  he  has  to  carry  the 
saucer  with  it,  or  else  to  drop  the  liquid  upon,  and  to 
soil  his  sheet,  or  his  bed-gowm,  or  pillow,  or  if  he  is  sit- 
ting up,  his  dress,  you  have  no  idea  what  a  difference 
this  minute  want  of  care  on  your  part  makes  to  his  com- 
fort and  even  to  his  willinf^ness  for  food. 


YII.  WHAT  FOOD  ? 

I  wdll  mention  one  or  two  of  the  most  common  errors  Common  er- 
rors in  diet, 
among  women  in  charge  of  sick  respecting  sick   diet. 

One  is  the  belief  that  beef  tea  is  the  most  nutritive  of  all 
articles.  Now,  just  try  and  boil  down  a  lb.  of  beef 
into  beef  tea,  evaporate  your  beef  tea,  and  see  what  Beef  tea. 
is  left  of  your  beef.  You  will  find  that  there  is  barely  a 
teaspoonful  of  solid  nourishment  to  half  a  pint  of  water 
in  beef  tea  ; — nevertheless  there  is  a  certain  reparative 
quality  in  it,  we  do  not  know  what,  as  there  is  in  tea ; — 
but  it  may  safely  be  given  in  almost  any  inflammatory  dis- 
ease, and  is  as  little  to  be  depended  upon  with  the  healthy 
or  convalescent  where  much  nourishment  is  required. 
Again,  it  is  an  ever  ready  saw  that  an  egg  is  equivalent 
to  a  lb.  of  meat, — whereas  it  is  not  at  all  so.  Also,  it  is 
seldom  noticed  with  how  many  patients,  particularly  of 


VO  XOTES    OX   NURSING. 

pegs.  nervous  or  bilious   temperament,   eggs    disagree.       All 

puddings  made  with  eggs,  are  distasteful  to  them  in  con- 
sequence. An  egg,  whipped  up  with  wine,  is  often  the 
only  form  in  which  they  can  take  this  kind  of  nourish- 
ment. Again,  if  the  patient  has  attained  to  eating 
meat,  it  is  supposed  that  to  give  him  meat  is  the  only 
thing  needful  for  his  recovery ;  whereas  scorbutic  sores 

Meat  with-    havc  bccn  actually  known  to  appear  among  sick  persons 

bies.  living  in  the  midst  of  plenty  in  England,  which  could 

be  traced  to  no  other  source  than  this,  viz. :  that  the 
nurse,  depending  on  meat  alone,  had  allowed  the  patient 
to  be  without  vegetables  for  a  considerable  time,  these 
latter  being  so  badly  cooked  that  he  always   left  them 

Arrowroot,  uutouched.  Arrowroot  is  another  grand  dependence  of 
the  nurse.  As  a  vehicle  for  wine,  and  as  a  restorative 
quickly  prepared,  it  is  all  very  well.  But  it  is  nothing 
but  starch  and  water.  Flour  is  both  more  nutritive, 
and  less  liable  to  ferment,  and  is  preferable  wherever  it 
can  be  used. 

Milk,  butter,  Again,  milk  and  the  preparations  from  milk,  are  a 
'  ■  most  important  article  of  food,  for  the  sick.  Butter  is 
the  lightest  kind  of  animal  fat,  and  though  it  wants  the 
sugar  and  some  of  the  other  elements  which  there  are  in 
milk,  yet  it  is  most  valuable  both  in  itself  and  in  en- 
abling the  patient  to  eat  more  bread.  Flour,  oats,  groats, 
barley,  and  their  kind,  are,  as  we  have  already  said,  pre- 
ferable in  all  their  preparations  to  all  the  preparations  of 
arrowroot,  sago,  tapioca,  and  their  kind.  Cream,  in  many 
long  chronic  diseases,  is  quite  irreplaceable  by  any  other 
article  whatever.  It  seems  to  act  in  the  same  manner  as 
beef  tea,  and  to  most  it  is  much  easier  of  digestion  than 
milk.  In  fact,  it  seldom  disagrees.  Cheese  is  not 
usually  digestible  by  the  sick,  but  it  is  pure  nourishment 


WHAT   FOOD  ?  71 

for  repairing  waste  ;  and  I  have  seen  sick,  and  not  a  few 
either,  whose  craving  for  cheese  shewed  how  much  it  was 
needed  by  them.* 

But,  if  fresh  milk  is  so  valuable  a  food  for  the  sick, 
the  least  change  or  sourness  in  it,  makes  it  of  all  arti- 
cles, perhaps,  the  most  injurious ;  diarrhoea  is  a  common 
result  of  fresh  milk  allowed  to  become  at  all  sour.  The 
nurse  therefore  ought  to  exercise  her  utmost  care  in  this. 
In  large  institutions  for  the  sick,  even  the  poorest,  the 
utmost  care  is  exercised.  Wenham  Lake  ice  is  used  for 
this  express  purpose  every  summer,  while  the  private  pa- 
tient, perhaps,  never  tastes  a  drop  of  milk  that  is  not 
sour,  all  through  the  hot  weather,  so  little  does  the  pri- 
vate nurse  understand  the  necessity  of  such  care.  Yet, 
if  you  consider  that  the  only  drop  of  real  nourishment  in 
your  patient's  tea  is  the  drop  of  milk,  and  how  much 
almost  all  English  patients  depend  upon  their  tea,  you 
will  see  the  great  importance  of  not  depriving  your  pa- 
tient of  this  drop  of  milk.  Buttermilk,  a  totally  differ- 
ent thing,  is  often  very  useful,  especially  in  fevers. 

In  lavinn^   down  rules  of   diet,  by  the  amounts  of  p.T^®* 

"       *=>  7       «'  things. 


*  In  the   diseases  produced  by  bad  food,  such  as  scorbutic  Intelligent 

dysentery  and  diarrhoea,  the  patient's  stomach  often  craves  for  pl^rtic^uiar' 

and  dio-ests  thine-s,  some  of  which  certainly  would  be  laid  down  sick  for  par- 
°.  ,  .  -,,..,  ,  .  „  tio.ular  arti- 

m  no  dietary  that  ever  was  invented  for  sick,  and  especially  not  clesof  diet. 

for  such  sick.     These  are  fruit,  pickles,  jams,  gingerbread,  fat  of 

ham  or  bacon,  suet,  cheese,  butter,  milk.     These  cases  I  have  seen 

not  by  ones,  nor  by  tens,   but  by  hundreds.     And  the  patient's 

stomach  was  right  and  the  book  was  wrong.     The  articles  craved 

for,  in  these  cases,  might  have  been  principally  arranged  under  the 

two  heads  of  fat  and  vegetable  acids. 

There  is  often  a  marked  difference  between  men  and  women 

in  this  matter  of  sick  feeding.     Women's  digestion  is  generally 

slower. 


72  NOTES    ON   NIJESING. 

"solid  nutriment"  in  different  kinds  of  fuod,  it  is  con- 
stantly lost  sight  of  what  the  patient  requires  to  repair 
his  waste,  what  he  can  take  and  what  he  can't.  You  can- 
not diet  a  patient  from  a  book,  you  cannot  make  up  the 
human  body  as  you  would  make  up  a  prescription, — so 
many  parts  "carboniferous,"  so  many  parts  "nitrogen- 
ous "  will  constitute  a  perfect  diet  for  the  patient.  The 
nurse's  observation  here  will  materially  assist  the  doctor 
— the  patient's  "  fancies  "  will  materially  assist  the  nurse. 
For  instance,  sugar  is  one  of  the  must  nutritive  of  all 
articles,  being  pure  carbon,  and  is  j)articularly  recom- 
mended in  some  books.  But  the  vast  majority  of  all 
patients  in  England,  young  and  old,  male  and  female, 
rich  and  poor,  hospital  and  private,  dishke  sweet  things, 
— and  while  I  have  never  known  a  person  take  to  sweets 
when  he  was  ill  who  disliked  them  when  he  was  well,  I 
have  known  many  fond  of  them  when  in  health,  who  in 
sickness  would  leave  off  anything  sweet,  even  to  sugar  in 
tea, — sweet  puddings,  sweet  drinks,  are  their  aversion ; 
the  furred  tongue  almost  always  likes  what  is  sharp  or 
pungent.  Scorbutic  patients  are  an  exception,  they  often 
crave  for  sweetmeats  and  jams. 
Jelly.  Jelly  is  another  article  of  diet  in  great  favour  with 

nurses  and  friends  of  the  sick ;  even  if  it  could  be  eaten 
solid,  it  would  not  nourish,  but  it  is  simply  the  height  of 
folly  to  take  ^  oz.  of  gelatine  and  make  it  into  a  certain 
bulk  by  dissolving  it  in  water  and  then  to  give  it  to  the 
sick,  as  if  the  mere  bulk  represented  nourishment.  It  is 
now  known  that  jelly  does  not  nourish,  that  it  has  a  ten- 
dency to  produce  diarrhoea, — -and  to  trust  to  it  to  repair 
the  waste  of  a  diseased  constitution  is  simply  to  starve 
the  sick  under  the  guise  of  feeding  them.  If  100  spoon- 
fuls of  jelly  were  given  in  the  course  of  the  day,  you  would 


WHAT   FOOD  ?  73 

have  given  one  spoonful  of  gelatine,  which  spoonful  has 
no  nutritive  power  whatever. 

And,  nevertheless,  gelatine  contains  a  large  quantity 
of  nitrogen,  which  is  one  of  the  most  powerful  elements 
in  nutrition  ;  on  the  other  hand,  beef  tea  may  be  chosen 
as  an  illustration  of  great  nutrient  power  in  sickness,  co- 
existing with  a  very  small  amount  of  solid  nitrogenous 
matter. 

Dr.  Christison  says  that  "every  one  will  be  struck  Beef  tea 
^  with  the  readiness  with  which  "  certain  classes  of  "  patients 
wdll  often  take  diluted  meat  juice  or  beef  tea  repeatedly, 
when  they  refuse  all  other  kinds  of  food."  This  is  par- 
ticularly remarkable  in  "  cases  of  gastric  fever,  in  which," 
he  says,  "  little  or  nothing  else  besides  beef  tea  or  diluted 
meat  juice  "  has  been  taken  for  weeks  or  even  months, 
"  and  yet  a  pint  of  beef  tea  contains  scarcely  ^  oz.  of  any- 
thing but  water," — the  result  is  so  striking  that  he  asks 
what  is  its  mode  of  action  "?  "  Not  simply  nutrient — ^  oz. 
of  the  most  nutritive  material  cannot  nearly  replace  the 
daily  wear  and  tear  of  the  tissues  in  any  circumstances- 
Possibly,"  he  says,  "  it  belongs  to  a  new  denomination  of 
remedies." 

It  has  been  observed  that  a  small  quantity  of  beef  tea 
added  to  other  articles  of  nutrition  augments  their  power 
out  of  all  proportion  to  the  additional  amount  of  solid 
malter. 

The  reason  whj  jelly  should  be  innutritions  and  beef 
tea  nutritious  to  the  sick,  is  a  secret  yet  undiscovered, 
but  it  clearly  shows  that  careful  observation  of  the  sick  is 
the  only  clue  to  the  best  dietary. 

Chemistry  has  as  yet  afforded  little  insif^ht  into  the  observation, 

•J  J  o  notcbemis- 

dieting:  of  sick.     All  that  chemistry  can  teU  us  is  the  try,  must  de- 

°  cide  sick 

amount  of  "  carboniferous  "  or  "  nitrogenous  "  elements  diet. 
4 


74  NOTES    ON   NUESING. 

discoverable  in  different  dietetic  articles.  It  has  given 
us  lists  of  dietetic  substances,  arranged  in  the  order  of 
their  richness  in  one  or  other  of  these  principles ;  but 
that  is  all.  In  the  great  majority  of  cases,  the  stomach 
of  the  patient  is  guided  by  other  principles  of  selection 
than  merely  the  amount  of  carbon  or  nitrogen  in  the  diet. 
No  doubt,  in  this  as  in  other  things,  nature  has  very 
definite  rules  for  her  guidance,  but  these  rules  can  only 
be  ascertained  by  the  most  careful  observation  at  the  bed- 
side. She  there  teaches  us  that  living  chemistry,  the^ 
chemistry  of  reparation,  is  something  different  from  the 
chemistry  of  the  laboratory.  Organic  chemistry  is  use- 
ful, as  all  knowledge  is,  when  we  come  face  to  face  with 
nature ;  but  it  by  no  means  follows  that  we  should  learn 
in  the  laboratory  any  one  of  the  reparative  processes  go- 
ing on  in  disease. 

Again,  the  nutritive  power  of  milk  and  of  the  pre- 
parations from  milk,  is  very  much  undervalued ;  there  is 
nearly  as  much  nourishment  in  half  a  pint  of  milk  as 
there  is  in  a  quarter  of  a  lb.  of  meat.  But  this  is  not  the 
whole  question  or  nearly  the  whole.  The  main  question 
is  what  the  patient's  stomach  can  assimilate  or  derive 
nourishment  from,  and  of  this  the  patient's  stomach  is 
the  sole  judge.  Chemistry  cannot  tell  this.  The  patient's 
stomach  must  be  its  own  chemist.  The  diet  which  will 
keep  the  healthy  man  healthy,  w  ill  kill  the  sick  one.  The 
same  beef  which  is  the  most  nutritive  of  all  meat  and 
which  nourishes  the  healthy  man,  is  the  least  nourishing 
of  all  food  to  the  sick  man,  whose  half-dead  stomach  can 
assimilate  no  part  of  it,  that  is,  make  no  food  out  of  it. 
On  a  diet  of  beef  tea  healthy  men  on  the  other  hand 
speedily  lose  their  strength. 
?read'™^*^^         I  havc  kuowu  paticuts  live  for  many  months  without 


WHAT   FOOD  ?  75 

toucliing  bread,  because  tbey  could  not  eat  baker's  bread. 
These  were,  mostly  country  patients,  but  not  all.  Home- 
made bread  or  brown  bread  is  a  most  important  article 
of  diet  for  many  patients.  The  use  of  aperients  may  be 
entirely  superseded  by  it.     Oat  cake  is  another. 

To  watch  for  the  opinions,  then,  which  the  patient's  Sound  ob- 

r  y  7  r  servation 

stomach  gives,  rather  than  to  read  "  analyses  of  foods,"  ^^!  scarcely 

°         '  -^  'yet  been 

is  the  business  of  all  those  who  have  to  settle  what  the  ^rought  to 

bear  on  sick 

patient  is  to  eat — perhaps  the  most  important  thing  to  <^^^- 
be  provided  for  him  after  the  air  he  is  to  breathe. 

Now  the  medical  man  who  sees  the  patient  only  once 
a  day  or  even  only  once  or  twice  a  week,  cannot  possibly 
tell  this  without  the  assistance  of  the  patient  himself,  or 
of  those  who  are  in  constant  observation  on  the  patient. 
The  utmost  the  medical  man  can  tell  is  whether  the 
patient  is  weaker  or  stronger  at  this  visit  than  he  was  at 
the  last  visit.  I  should  therefore  say  that  incomparably 
the  most  important  office  of  the  nurse,  after  she  has  taken 
care  of  the  patient's  air,  is  to  take  care  to  observe  the 
effect  of  his  food,  and  report  it  to  the  medical  attendant. 

It  is  quite  incalculable  the  good  that  would  certainly 
come  from  such  sound  and  close  observation  in  this  al- 
most neglected  branch  of  nursing,  or  the  help  it  would 
give  to  the  medical  man. 

A  great  deal  too  much  against  tea  *  is  said  by  wise  Tea  and  cof 

fee. 

*  It  is  made  a  frequent  recommendation  to  persons  about  to 
incur  great  exhaustion,  either  from  the  nature  of  the  service,  or 
from  their  being  not  in  a  state  fit  for  it,  to  eat  a  piece  of  bread 
before  they  go.  I  wish  the  recomnienders  would  themselves  try 
the  experiment  of  substituting  a  piece  of  bread  for  a  cup  of  tea 
or  coffee,  or  beef-tea,  as  a  refresher.  They  would  find  it  a  very 
poor  comfort.  "When  soldiers  have  to  set  out  fasting  on  fatiguing 
duty,  when  nurses  have  to  go  fasting  in  to  their  patients,  it  is  a 
hot  restorative  they  want,  and  ought  to  have,  before  they  go,  not 


76  NOTES    ON   NURSING. 

people,  and  a  great  deal  too  much  of  tea  is  given  to  the 
sick  by  foolish  people.  When  you  see  the  natural  and 
almost  universal  craving  in  English  sick  for  their  "  tea," 
you  cannot  but  feel  that  nature  knows  what  she  is  about. 
But  a  little  tea  or  cojffee  restores  them  quite  as  much  as 
a  great  deal,  and  a  great  deal  of  tea  and  especially  of 
coffee  impairs  the  little  power  of  digestion  they  have. 
Yet  a  nurse,  because  she  sees  how  one  or  two  cups  of  tea 
or  coffee  restores  her  patient,  thinks  that  three  or  four 
cups  will  do  twice  as  much.  This  is  not  the  case  at  all ; 
it  is  however  certain  that  there  is  nothing  yet  discovered 
which  is  a  substitute  to  the  English  patient  for  his  cup 
of  tea ;  he  can  take  it  when  he  can  take  nothing  else, 
and  he  often  can't  take  anything  else  if  he  has  it  not. 
I  should  be  very  glad  if  any  of  the  abusers  of  tea  would 
point  out  what  to  give  to  an  English  patient  after  a 
sleepless  night,  instead  of  tea.  If  you  give  it  at  5  or  6 
o'clock  in  the  morning,  he  may  even  sometimes  fall  asleep 

a  cold  bit  of  bread.  And  dreadful  have  been  the  consequences 
of  neglecting  this.  If  they  can  take  a  bit  of  bread  with  the  hot 
cup  of  tea,  so  much  the  better,  but  not  instead  of  it.  The  fact 
that  there  is  more  nourishment  in  bread  than  in  almost  anything 
else,  has  probably  induced  the  mistake.  That  it  is  a  fatal  mis- 
take, there  is  no  doubt.  It  seems,  though  very  little  is  known  on 
the  subject,  that  what  "  assimilates  "  itself  directly,  and  with  the 
least  trouble  of  digestion  with  the  human  body,  is  the  best  for  the 
above  circumstances.  Bread  requires  two  or  three  processes  of 
assimilation,  before  it  becomes  like  the  human  body. 

The  almost  universal  testimony  of  English  men  and  women 
who  have  undergone  great  fatigue,  such  as  riding  long  journeys 
without  stopping,  or  sitting  up  for  several  nights  in  succession,  is 
that  they  could  do  it  best  upon  an  occasional  cup  of  tea — and 
nothing  else. 

Let  experience,  not  theory,  decide  upon  this  as  upon  all  other 
thinirs. 


WHAT   FOOD  ?  77 

after  it,  and  get  perhaps  his  only  two  or  three  hours' 
sleep  during  the  twenty-four.  At  the  same  time  you 
never  should  give  tea  or  coffee  to  the  sick,  as  a  rule,  after  5 
o'clock  in  the  afternoon.  Sleeplessness  in  the  early 
night  is  from  excitement  generally  and  is  increased  by 
tea  or  coffee  ;  sleeplessness  w^hich  continues  to  the  early 
morning  is  from  exhaustion  often,  and  is  relieved  by  tea. 
The  only  English  patients  I  have  ever  known  refuse  tea, 
have  been  typhus  cases,  and  the  first  sign  of  their  getting 
better  was  their  craving  again  for  tea.  In  general,  the 
dry  and  dirty  tongue  always  prefers  tea  to  coffee,  and 
will  quite  decline  milk,  unless  with  tea.  Coffee  is  a  bet- 
ter restorative  than  tea,  but  a  greater  impairer  of  the  di- 
gestion. Let  the  patient's  taste  decide.  You  will  say 
that,  in  cases  of  great  thirst,  the  patient's  craving  de- 
cides that  it  will  drink  a  great  deal  of  tea,  and  that  you 
cannot  help  it.  But  in  these  cases  be  sure  that  the  pa- 
tient requires  diluents  for  quite  other  purposes  than 
quenching  the  thirst ;  he  wants  a  great  deal  of  some 
drink,  not  only  of  tea,  and  the  doctor  will  order  what  he 
is  to  have,  barley  water  or  lemonade,  or  soda  water  and 
milk,  as  the  case  may  be. 

Lehman,  quoted  by  Dr.  Christison,  says  that,  among 
the  well  and  active  "  the  infusion  of  1  oz.  of  roasted 
coffee  daily  will  diminish  the  waste  "  going  on  in  the 
body"  "by  one-fourth,"  and  Dr.  Christison  adds  that 
tea  has  the  same  property.  Now  this  is  actual  experi- 
ment. Lehman  weighs  the  man  and  finds  the  fact  from 
his  weight.  It  is  not  deduced  from  any  "  analysis  "  of 
food.  All  experience  among  the  sick  shows  the  same 
thing.* 

*  In  making  coffee,  it  is  absolutely  necessary  to  buy  it  in  the 
berry  and  grind  it  at  home.     Otherwise  you  may  rjckon  upon  its 


78  NOTES    ON   NTJESING. 

CJocoa.  Cocoa  is  often  recommended  to  the  sick  in  lieu  of  tea 

or  coffee.  But  independently  of  the  fact  that  English 
sick  very  generally  dislike  cocoa,  it  has  quite  a  different 
effect  from  tea  or  coffee.  It  is  an  oily  starchy  nut  hav- 
ing no  restorative  power  at  all,  but  simply  increasing  fat. 
It  is  pure  mockery  of  the  sick,  therefore,  to  call  it  a  sub- 
stitute for  tea.  For  any  renovating  stimulus  it  has,  you 
might  just  as  well  offer  them  chestnuts  instead  of  tea. 

Balk.  j^j^  almost  universal  error  among  nurses  is  in  the 

bulk  of  the  food  and  especially  the  drinks  they  offer  to 
their  patients.  Suppose  a  patient  ordered  4  oz.  brandy 
during  the  day,  how  is  he  to  take  this  if  you  make  it 
into  four  pints  with  diluting  it  ?  The  same  with  tea  and 
beef  tea,  with  arrowroot,  milk,  &g.  You  have  not  in- 
creased the  nourishment,  you  have  not  increased  the  ren- 
ovating power  of  these  articles,  by  increasing  their  bulk, 
— you  have  very  likely  diminished  both  by  giving  the 

containing  a  certain  amount  of  chicory,  at  least.  This  is  not  a 
question  of  the  taste,  or  of  the  wholesomeness  of  chicory.  It  is 
that  chicory  has  nothing  at  all  of  the  properties  for  which  you 
give  coffee.     And  therefore  you  may  as  well  not  give  it. 

Again,  all  laundresses,  mistresses  of  dairy-farms,  head  nurses, 
(I  speak  of  the  good  old  sort  only — women  who  unite  a  good  deal 
of  hard  manual  labour  with  the  head-work  necessary  for  arranging 
the  day's  business,  so  that  none  of  it  shall  tread  upon  the  heels 
of  something  else,)  set  great  value,  I  have  observed,  upon  having 
a  high-priced  tea.  This  is  called  extravagant.  But  these  women 
are  "  extravagant "  in  nothing  else.  And  they  are  right  in  this. 
Keal  tea-leaf  tea  alone  contains  the  restorative  they  want ;  which  is 
not  to  be  found  in  sloe-leaf  tea. 

The  mistresses  of  houses,  who  cannot  even  go  over  their  own 
house  once  a  day,  are  incapable  of  judging  for  these  women.  For 
they  are  incapable  themselves,  to  all  appearance,  of  the  spirit  of 
arrangement  (no  small  task)  necessary  for  managing  a  large  ward 
or  dairy. 


BED   AND   BEDDING.  79 

patient's  digestion  more  to  do,  and  most  likely  of  all,  the 
patient  will  leave  half  of  what  he  has  been  ordered  to 
take,  because  he  cannot  swallow  the  bulk  with  which  you 
have  been  pleased  to  invest  it.  It  requires  very  nice  ob- 
servation and  care  (and  meets  with  hardly  any)  to  deter- 
mine what  will  not  be  too  thick  or  strong  for  the  patient 
to  take,  while  giving  him  no  more  than  the  bulk  which 
he  is  able  to  swallow. 


VIII.   BED   AXD   BEDDING. 
A  few  words  upon  bedsteads  and  bedding  ;  and  prin-  Fevensh- 

.  .      ,  nessasvmp 

cipally  as  regards  patients  who  are  entu'ely,  or  almost  tom  of  bed- 
entirely,  confined  to  bed. 

Feverishness  is  generally  supposed  to  be  a  symptom 
of  fever — in  nine  cases  out  of  ten  it  is  a  symptom  of  bed- 
ding.* The  patient  has  had  re-introduced  into  the  body 
the  emanations  from  himself  which  day  after  day  and  week 
after  week  saturate  his  unaired  bedding.  How  can  it 
be  otherwise  ?  Look  at  the  ordinary  bed  in  which  a  pa- 
tient lies. 

If  I  were  looking  out  for  an  example  in  order  to  show  Uncieanii- 

1,  iiTi-iiTi  .  P  T     °^^^  "^  ordi- 

wnat  not  to  do,  i  should  take  the  specimen  of  an  orai-  nary  bed- 
nary  bed  in  a  private  house :  a  wooden  bedstead,  two  or 
even  three  mattresses  piled  up  to  above  the  height  of  a 
table  ;  a  vallance  attached  to  the  frame — nothing?  but  a 


*  I  once  told  a  "  very  good  nurse"  that  the  way  in  which  her  Nurses  oftcr. 
,.      ,,  ,       ,  .,  ,    ,  ",/.,.,  do  not  think 

patient  s  room  was  kept  was  quite  enough  to  account  lor  his  sleep-  the  sick 

lessness;  and  she  answered  quite  good-humouredly  she  was  not  at  [*'*'"'  ''^^"-^' . 

all  surprised  at  it — as  if  the  state  of  the  room  were,  Uke  the  state  theirs,  hut 

of  the  weather,  entirely  out  of  her  power.     Now  in  what  sense  s^if. 

was  this  woman  to  be  called  a  *'  nurse  ?" 


80  NOTES    ON   NUESING. 

miracle  could  ever  thoroughly  dry  or  air  such  a  hed  and 
bedding.  The  patient  must  inevitably  alternate  between 
cold  damp  after  his  bed  is  made,  and  warm  damp  before, 
both  saturated  with  organic  matter,*  and  this  from  the 
time  the  mattresses  are  put  under  him  till  the  time  they 
are  picked  to  pieces,  if  this  is  ever  done. 
Air  your  If  you  consider  that  an  adult  in  health  exhales  by 

dirty  sheets,  ''  *' 

not  only       the  lunffs  and  skin  in  the  twenty-four  hours  three  pints 

your  clean  °  ^  x 

ones.  at  least  of  moisture,  loaded  with  organic  matter  ready  to 

enter  into  putrefaction ;  that  in  sickness  the  quantity  is 
often  greatly  increased,  the  quality  is  always  more  noxious 
— just  ask  yourself  next  where  does  all  this  moisture  go 
to  %  Chiefly  into  the  bedding,  because  it  cannot  go  any- 
where else.  And  it  stays  there ;  because,  except  per- 
haps a  weekly  change  of  sheets,  scarcely  any  other  airing 
is  attempted.  A  nurse  will  be  careful  to  fidgetiness 
about  airing  the  clean  sheets  from  clean  damp,  but  air- 
ing the  dirty  sheets  from  noxious  damp  will  never  even 
occur  to  her.  Besides  this,  the  most  dangerous  effluvia 
we  know  of  are  from  the  excreta  of  the  sick — these  are 
placed,  at  least  temporarily,  where  they  must  throw  their 
effluvia  into  the  under  side  of  the  bed,  and  the  space  un- 
der the  bed  is  never  aired ;  it  cannot  be,  with  our  ar- 
rangements. Must  not  such  a  bed  be  always  saturated, 
and  be  always  the  means  of  re-introducing  into  the  sys- 
tem of  the  unfortunate  patient  who  lies  in  it,  that  excre- 
mentitious  matter  to  eliminate  ^vhich  from  the  body  na- 
ture had  expressly  appointed  the  disease  % 

*  For  the  same  reason  if,  after  washing  a  patient,  you  must 
put  the  same  night-dress  on  him  again,  always  give  it  a  prelimi- 
nary warm  at  the  fire.  The  night-gown  he  has  worn  must  be,  to 
a  certain  extent,  damp.  It  has  now  got  cold  from  having  been 
off  him  for  a  few  minutes.  The  fire  will  dry  and  at  the  same  time 
air  it.     This  is  mucb  more  important  than  with  clean  things. 


BED    AND    BEDDING.  81 

My  heart  always  sinks  within  me  when  I  hear  the 
good  house- wife,  of  every  class,  say,  "  I  assure  you  the 
bed  has  been  well  slept  in,"  and  I  can  only  hope  it  is  not 
true.  What  1  is  the  bed  already  saturated  with  some- 
body else's  damp  before  my  patient  comes  to  exhale  in  it 
his  own  damp  1  Has  it  not  had  a  single  chance  to  be 
aired  ?  No,  not  one.  "  It  has  been  slept  in  every 
night." 

The  only  way  of  really  nursing  a  real  patient  is  to  iron  spring 
have  an  iron  bedstead,  with  rheocline  springs,  which  are  the  best 
permeable  by  the   air   up  to   the  very  mattress  (no  val- 
lance,  of  course),  the  mattress  to  be  a  thin  hair  one  ;  the 
bed  to  be  not  above  3^  feet  wide.     If  the  patient  be  en- 
tirely confined  to  his  bed,  there  should  be  two  such  bed-  Comfort  and 

"  cleanliness 

steads;  each  bed  to  be  "made"  with  mattress,  sheets,  of  two  h^ds. 

blankets,  <fec.,  complete — the  patient  to  pass  twelve  hours 

in  each  bed  ;  on  no  account  to  carry  his  sheets  with  him. 

The  whole  of  the  bedding  to  be  hung  up  to  air  for  each 

intermediate  twelve  hours.     Of  course  there  are  many 

cases  where  this  cannot  be  done  at  all — many  more  where 

only  an  approach  to  it  can  be  made.     I  am  indicating 

the  ideal  of  nursing,  and  what  I  have  actually  had  done. 

But  about  the  kind  of  bedstead  there  can  be  no  doubt, 

whether  there  be  one  or  tw^o  provided. 

There  is  a  prejudice  in  favour  of  a  wide  bed — I  be-  Bed  not  to 

.  ATI!  f      1  c  ^^  too  wide. 

neve  it  to  be  a  prejudice.  All  the  refreshment  of  mov- 
ing a  patient  from  one  side  to  the  other  of  his  bed  is  far 
more  effectually  secured  by  putting  him  into  a  fresh  bed  ; 
and  a  patient  who  is  really  very  ill  does  not  stray  far  in 
bed.  But  it  is  said  there  is  no  room  to  put  a  tray  down 
on  a  narrow  bed.  No  good  nurse  will  ever  put  a  tray  on 
abed  at  all.  If  the  patient  can  turn  on  his  side,  he  will 
eat  more  comfortably  from  a  bed-side  table  ;  and  on  no 


82  NOTES    ON   NUKSING. 

account  whatever  should  a  bed  ever  be  liigber  than  a 
sofa.  Otherwise  the  patient  feels  himself  "  out  of  hu- 
manity's reach  ;  "  he  can  get  at  nothing  for  himself :  he 
can  move  nothing  for  himself.  If  the  patient  cannot  turn, 
a  table  over  the  bed  is  a  better  thing.  I  need  hardly 
say  that  a  patient's  bed  should  never  have  its  side  against 
the  wall.  The  nurse  must  be  able  to  get  easily  to  both 
sides  of  the  bed,  and  to  reach  easily  every  part  of  the  pa- 
tient without  stretching — a  thing  impossible  if  the  bed 
be  either  too  wide  or  too  high. 
Bed  not  to  When  I  see  a  patient  in  a  room  nine  or  ten  feethio^h 

be  too  high.  •'•  " 

upon  a  bed  between  four  and  five  feet  high,  w^ith  his 
head,  when  he  is  sitting  up  in  bed,  actually  within  two 
or  three  feet  of  the  ceiling,  I  ask  myself,  is  this  expressly 
j)lanned  to  produce  that  peculiarly  distressing  feeling 
common  to  the  sick,  viz.,  as  if  the  walls  and  ceiling  were 
closing  in  upon  them,  and  they  becoming  sandwiches  be- 
tween floor  and  ceiling,  which  imagination  is  not,  indeed, 
here  so  far  from  the  truth  1  If,  over  and  above  this,  the 
window  stops  short  of  the  ceiling,  then  the  patient's  head 
may  literally  be  raised  above  the  stratum  of  fresh  air, 
even  when  the  window  is  open.  Can  human  perversity 
any  farther  go,  in  unmaking  the  process  of  restoration 
which  God  has  made  ?  The  fact  is,  that  the  heads  of 
sleepers  or  of  sick  should  never  be  higher  than  the  throat 
of  the  chimney,  w^hich  ensures  their  being  in  the  current 
of  best  air.  And  we  will  not  suppose  it  possible  that  you 
have  closed  your  chimney  wdth  a  chimney-board. 

If  a  bed  is  higher  than  a  sofa,  the  difierence  of  the 
fatigue  of  getting  in  and  out  of  bed  will  just  make  the 
difference,  very  often,  to  the  patient  (who  can  get  in  and 
out  of  bed  at  all)  of  being  able  to  take  a  few  minutes' 
exercise,  either  in  the  open  air  or  in  another  room.     It 


BED   AJ^D   BEDDING.  83 

is  so  very  odd  that  people  never  think  of  this,  or  of  how 
many  more  times  a  patient  who  is  in  bed  for  the  twenty- 
four  hours  is  obliged  to  get  in  and  out  of  bed  than  they 
are,  who  only,  it  is  to  be  hoped,  get  into  bed  once  and 
out  of  bed  once  during  the  twenty-four  hours. 

A  patient's  bed  should  always  be  in  the  lio-htest  spot  Nor  in  a 

.        1  -.1        1        n  1         -,  -1  °        .     ,  dark  place. 

m  the  room  ;  and  he  should  be  able  to  see  out  of  wmdow. 

I  need  scarcely  say  that  the  old  four-post  bed  with  Nor  a  four 
curtains  is  utterly  inadmissible,  whether  for  sick  or  well,  curtains. 
Hospital  bedsteads  are  in  many  respects  very  much  less 
objectionable  than  private  ones. 

There  is  reason  to  believe  that  not  a  few  of  the  appa-  Scrofula  of- 

^ -^        ten  a  result 

rently  unaccountable   cases  of  scrofula  amonsr  children  of  disposi- 

•^  ,  ^  tionofbed 

proceed  from  the  habit  of  sleeping  with  the  head  under  clothes, 
the  bed  clothes,  and  so  inhaling  air  already  breathed, 
which  is  farther  contaminated  by  exhalations  from  the 
skin.  Patients  are  sometimes  given  to  a  similar  habit, 
and  it  often  happens  that  the  bed  clothes  are  so  disposed 
that  the  patient  must  necessarily  breathe  air  more  or  less 
contaminated  by  exhalations  from  his  skin.  A  good 
nurse  will  be  careful  to  attend  to  this.  It  is  an  impor 
taut  part,  so  to  speak,  of  ventilation. 

It  may  be  worth  while  to  remark,  that  where  there  is  Bed  sores, 
any  danger  of  bed-sores  a  blanket  should  never  be  placed 
under    the  patient.     It  retains  damp   and    acts  like  a 
poultice. 

Xever  use  anything  but  light  Whitney  blankets  as  Heavy  and 
bed  covering  for  the  sick.  The  heavy  cotton  impervious  bed  c^iothel 
counterpane  is  bad,  for  the  very  reason  that  it  keeps  in 
the  emanations  from  the  sick  person,  while  the  blanket 
allows  them  to  pass  tlirough.  Weak  patients  are  inva- 
riably distressed  by  a  great  weight  of  bed  clothes,  which 
often  prevents  their  getting  any  sound  sleep  whatever. 


84  NOTES    ON   NURSING. 

Note. — One  word  about  pillows.  Every  weak  patient,  be  his 
illness  what  it  may,  suffers  more  or  less  from  difficulty  in  breath- 
ing. To  take  the  weight  of  the  body  off  the  poor  chest,  which 
is  hardly  up  to  its  work  as  it  is,  ought  therefore  to  be  the  object 
of  the  nurse  in  arranging  his  pillows.  Xow  what  does  she  do  and 
what  are  the  consequences  ?  She  piles  the  pillows  one  a-top  of 
the  other  like  a  wall  of  bricks.  The  head  is  thrown  upon  the 
chest.  And  the  shoulders  are  pushed  forward,  so  as  not  to  allow 
the  lungs  room  to  expand.  The  pillows,  in  fact,  lean  upon  the 
patient,  not  the  patient  upon  the  pillows.  It  is  impossible  to  give 
a  rule  for  this,  because  it  must  vary  with  the  figure  of  the  patient. 
And  tall  patients  suffer  much  more  than  short  ones,  because  of 
the  drag  of  the  long  limbs  upon  the  waist.  But  the  object  is  to 
support,  with  the  pillows,  the  back  below  the  breathing  apparatus, 
to  allow  the  shoulders  room  to  fall  back,  and  to  support  the  head, 
without  throwing  it  forward.  The  suffering  of  dying  patients  is 
immensely  increased  by  neglect  of  these  points.  And  many  an 
invalid,  too  weak  to  drag  about  his  pillows  himself,  slips  his  book 
or  anything  at  hand  behind  the  lower  part  of  his  back  to  sup- 
port it. 


IX.  LIGHT. 

tiiuo^bSth"  I^  is  the  unqualified  result  of  all  my  experience  with 
recov^^'^  the  sick,  that  second  only  to  their  need  of  fresh  air  is 
their  need  of  light ;  that,  after  a  close  room,  what  hurts 
them  most  is  a  dark  room.  And  that  it  is  not  only  light 
but  direct  sun-light  they  want.  I  had  rather  have  the 
power  of  carrying  my  patient  about  after  the  sun,  ac- 
cording to  the  aspect  of  the  rooms,  if  circumstances  per- 
mit, than  let  him  linger  in  a  room  when  the  sun  is  off. 
People  think  the  effect  is  upon  the  spirits  only.  This  is 
by  no  means  the  case.  The  sun  is  not  only  a  painter 
but  a  sculptor.  You  admit  that  he  does  the  photograph. 
Without  going  into  any  scientific  exposition  we  must  ad- 
mit that  light  has  quite  as  real  and  tangible  effects  upon 


LIGHT.  85 

the  human  body.  But  this  is  not  alL  Who  has  not 
observed  the  purifying  effect  of  light,  and  especially  of 
direct  sunlight,  upon  the  air  of  a  room  ?  Here  is  an  ob- 
servation within  everybody's  experience.  Go  into  a 
room  where  the  shutters  are  always  shut  (in  a  sick  room 
or  a  bedroom  there  should  never  be  shutters  shut),  and 
though  the  room  be  uninhabited,  though  the  air  has  never 
been  polluted  by  the  breathing  of  human  beings,  you  will 
observe  a  close,  musty  smell  of  corrupt  air,  of  air  i.  e. 
unpurified  by  the  effect  of  the  sun's  rays.  The  musti- 
ness  of  dark  rooms  and  corners,  indeed,  is  proverbial. 
The  cheerfulness  of  a  room,  the  usefulness  of  light  in 
treating  disease  is  all-important. 

A  very  high  authority  in  hospital  construction  has  Aspect, 

•  Ti  11  1  -TiT^  view,  and 

said  that  people  do  not  enou^^h  consider  the  difference  sunlight 

1  1  11  ...  1  .  ,.-,,-,     matters  of 

between  wards  and  dormitories  m  planning  their  build-  first  impor- 

T-.         X  PI  1  111-1  1     tance  to  the 

mgs.  But  i  go  larther,  and  say,  that  healthy  people  si.jk. 
never  remember  the  difference  between  bed-rooms  and 
sick'TOoms,  in  making  arrangements  for  the  sick.  To  a 
sleeper  in  health  it  does  not  signify  what  the  view  is 
from  his  bed.  He  ought  never  to  be  in  it  excepting 
when  asleep,  and  at  night.  Aspect  does  not  very  much 
signify  either  (provided  the  sun  reach  his  bed-room  some 
time  in  every  day,  to  purify  the  air),  because  he  ought 
never  to  be  in  his  bed-room  except  during  the  hours  when 
there  is  no  sun.  But  the  case  is  exactly  reversed  with 
the  sick,  even  should  they  be  as  many  hours  out  of  their 
beds  as  you  are  in  yours,  which  probably  they  are  not. 
Therefore,  that  they  should  be  able,  without  raising  them- 
selves or  turning  in  bed,  to  see  out  of  window  from  their 
beds,  to  see  sky  and  sun-light  at  least,  if  you  can  show 
them  nothing  else,  I  assert  to  be,  if  not  of  the  very  first 
importance  for  recovery,  at  least  something  very  near  it. 


86  NOTES    ON   NUKSING. 

And  you  slioiild  tlierefore  look  to  tbe  position  of  the  beds 
of  your  sick  one  of  the  very  first  things.  If  they  can 
see  out  of  two  windows  instead  of  one,  so  much  the  bet- 
ter. Again,  the  morning  sun  and  the  mid-day  sun — the 
hours  when  they  are  quite  certain  not  to  be  up,  are  of 
more  importance  to  them,  if  a  choice  must  be  made,  than 
the  afternoon  sun.  Perhaps  you  can  take  them  out  of 
bed  in  the  afternoon  and  set  them  by  the  window,  where 
they  can  see  the  sun.  But  the  best  rule  is,  if  possible, 
to  give  them  direct  sunlight  from  the  moment  he  rises 
till  the  moment  he  sets. 

Another  great  difference  between  the  bed-ioom.  and 
the  sick-ioom.  is,  that  the  sleeper  has  a  very  large  balance 
of  fresh  air  to  begin  with,  when  he  begins  the  night,  if 
his  room  has  been  open  all  day  as  it  ought  to  be  ;  the 
sick  man  has  not,  because  all  day  he  has  been  breathing 
the  air  in  the  same  room,  and  dirtying  it  by  the  emana- 
tions from  himself.  Far  more  care  is  therefore  necessary 
to  keep  up  a  constant  change  of  air  in  the  sick  room. 

It  is  hardly  necessary  to  add  that  there  are  acute 
cases  (particularly  a  few  ophthalmic  cases,  and  diseases 
where  the  eye  is  morbidly  sensitive),  where  a  subdued 
light  is  necessary.  But  a  dark  north  room  is  inadmis- 
sible even  for  these.  You  can  always  moderate  the 
light  by  blinds  and  curtains. 

Heavy,  thick,  dark  window  or  bed  curtains  should, 
however,  hardly  ever  be  used  for  any  kind  of  sick  in  this 
country.  A  light  white  curtain  at  the  head  of  the  bed 
is,  in  general,  all  that  is  necessary,  and  a  green  blind  to 
the  window,  to  be  drawn  down  only  when  necessary. 
Without  One  of  the  greatest  observers  of  human  things  (not 

sunlight,  -we  °  o      v 

degenertite    phvsiolooical),  says,  in  another  lano-uao^e,    "  Where  there 

body  and        -     "  o  /?        ./    :  o      o   ? 

n"n<L  is  sun  there  is  thought."     All  physiology  goes  to  confirm 


CLEAXiMJS'ESS    OF    EOOMS    AND    W^VJXS.  87 

this.  Where  is  the  shady  side  of  deep  vallies,  there  is 
cretinism.  Where  are  cellars  and  the  unsunned  sides  of 
narrow  streets,  there  is  the  degeneracy  and  weakliness 
of  the  human  race — mind  and  body  equally  degenerating. 
Put  the  pale  withering  plant  and  human  being  into  the 
sun,  and,  if  not  too  far  gone,  each  will  recover  health  and 
spirit. 

It   is   a    curious    thins^    to  observe   how  almost  all  Almost  all 

°  ^  patients  lie 

patients  lie  with  their  faces  turned  to  the  light,  exactly  ^^ith  thdr 
as  plants  always  make  their  way  towards  the  light ;  a  ligi^t. 
patient  will  even  complain  that  it  gives  him  pain  "  lying 
on  that  side."  "  Then  why  do  you  lie  on  that  side  ?  " 
He  does  not  know, — but  we  do.  It  is  because  it  is  the 
side  towards  the  window.  A  fashionable  physician  has 
recently  published  in  a  government  report  that  he  always 
turns  his  patient's  faces  from  the  light.  Yes,  but  nature 
is  stronger  than  fashionable  physicians,  and  depend  upon 
it  she  turns  the  faces  back  and  toiuards  such  light  as  she 
can  get.  Walk  through  the  wards  of  a  hospital,  remem- 
ber the  bed  sides  of  private  patients  you  have  seen,  and 
count  how  many  sick  you  ever  saw  lying  with  their 
faces  towards  the  wall. 


X.  CLEANLINESS  OF  ROOMS  AND  WALLS. 

It  cannot  be  necessary  to  tell  a  nurse  that  she  should  Cleanliness 
be  clean,  or  that  she  should  keep  her  patient  clean, —  and  fumi- 

1  ,  p  .  .         .  ture. 

seemg  that  the  greater  part  oi  nursmg  consists  m  pre- 
serving cleanliness.  No  ventilation  can  freshen  a  room 
or  ward  where  the  most  scrupulous  cleanliness  is  not 
observed.  Unless  the  wind  be  blowing  through  the 
windows  at  the  rate  of  twenty  miles  an  hour,  dusty 
carpets,   dirty  wainscots,  musty  curtains  and  furniture, 


88  NOTES    ON   NURSING. 

will  infallibly  produce  a  close  smell.  I  have  lived  in  a 
large  and  expensively  furnished  London  house,  where  the 
only  constant  inmate  in  two  very  lofty  rooms,  with  oppo- 
site windows,  was  myself,  and  yet,  owing  to  the  above- 
mentioned  dirty  circumstances,  no  opening  of  windows 
could  ever  keep  those  rooms  free  from  closeness ;  but  the 
carpet  and  curtains  having  been  turned  out  of  the  rooms 
altogether,  they  became  instantly  as  fresh  as  could  be 
-wished.  It  is  pure  nonsense  to  say  that  in  London  a 
room  cannot  be  kept  clean.  Many  of  our  hospitals  show 
the  exact  reverse. 
Dust  never  But  no  particle  of  dust  is  ever  or  can  ever  be  removed 

removed  -i  -,       c  •,         -,  ^     ^        • 

DOW.  or  really  got  nd  of  by  the  present  system  oi  dustmg. 

Dusting  in  these  days  means  nothing  but  flapping  the 
dust  from  one  part  of  a  room  on  to  another  with  doors 
and  windows  closed.  What  you  do  it  for  I  cannot 
think.  You  had  much  better  leave  the  dust  alone,  if  you 
are  not  going  to  take  it  away  altogether.  For  from  the 
time  a  room  begins  to  be  a  room  up  to  the  time  when  it 
ceases  to  be  one,  no  one  atom  of  dust  ever  actually  leaves 
its  precincts.  Tidjdng  a  room  means  nothing  now  but 
removing  a  thing  from  one  place,  which  it  has  kept 
clean  for  itself,  on  to  another  and  a  dirtier  one.*  Flap- 
How  a  room  *  jf  you  like  to  clean  your  furniture  by  laying  out  your  clean 
li  dusted.        ,    ,        ^  J.  X       -u  .  r    J'    '  '        .  •  1 

clothes  upon  your  dirty  cnairs  or  soia,  this  is  one  way  certainly 

of  doing  it.  Having  witnessed  the  morning  process  called  "  tidy 
ing  the  room,"  for  many  years,  and  with  ever-increasing  astonish' 
inent,  I  can  describe  what  it  is.  From  the  chairs,  tables,  or  sofa, 
upon  which  the  "things"  have  lain  during  the  night,  and  which 
are  therefore  comparatively  clean  from  dust  or  blacks,  the  poor 
"  things''''  having  "  caught"  it,  they  are  removed  to  other  chairs, 
tables,  sofas,  upon  which  you  could  write  your  name  with  your 
finger  in  the  dust  or  blacks.  The  other  side  of  the  "  things "  is 
therefore  now  evenly  dirtied  or  dusted.  The  housemaid  then  flaps 
everything,  or  some  things,   not  out  of  her  reach,  with  a  thing 


CLEANLINESS   OP   ROOMS   AND   WALLS.  89 

ping  by  way  of  cleaning  is  only  admissible  in  the  case 
of  pictures,  or  anything  made  of  paper.  The  only  way  I 
know  to  remove  dust,  the  plague  of  all  lovers  of  fresh  air, 
is  to  wipe  everything  with  a  damp  cloth.  And  all  fur- 
niture ought  to  be  so  made  as  that  it  may  be  wiped  with 
a  damp  cloth  without  injury  to  itself,  and  so  polished  as 
that  it  may  be  damped  without  injury  to  others.  To 
dust,  as  it  is  now  practised,  truly  means  to  distribute 
dust  more  equally  over  a  room. 

As  to  floors,  the  only  really  clean  floor  I  know  is  the  Floors. 
Berlin  lackered  floor,  which  is  wet  rubbed  and  dry  rubbed 
every  morning  to  remove  the  dust.  The  Yi^vlq\i  imrquet 
is  always  more  or  less  dusty,  although  infinitely  superior 
in  point  of  cleanliness  and  healthiness  to  our  absorbent 
floor. 

For  a  sick  room,  a  carpet  is  perhaps  the  worst  expe- 
dient which  could  by  any  possibility  have  been  invent- 
ed. If  you  must  have  a  carpet,  the  only  safety  is  to 
take  it  up  two  or  three  times  a  year,  instead  of  once.  A 
dirty  carpet  literally  infects  the  room.  And  if  you  con- 
sider the  enormous  quantity  of  organic  matter  from  the 
feet  of  people  coming  in,  which  must  saturate  it,  this  is 
by  no  means  surprising. 

As  for  walls,  the  worst  is  the  papered  wall ;  the  next  ^gJJ^^ 
worst  is  plaster.     But  the  plaster  can  be  redeemed  by  oji-rminted 
frequent  lime-washing ;   the  paper  requires  frequent  re- 
newing.    A  glazed  paper  gets  rid  of  a  good  deal  of  the 
danger.     But  the  ordinary  bed-room  paper  is  all  that  it 
ought  not  to  be.* 

called  a  duster — the  dust  flies  up,  then  re-settles  more  equally 

than  it  lay  before  the  operation.     The  room  has  now  been  "  put 

.   ,       „  Atmosphere 

to  rights."  in  painted 

*  I  am  sure  that  a  person  who  has  accustomed  her  senses  to  r"onE'Tu[to 

compare  atmospheres  proper  and  improper  for  the  sick  and  for  distinguish- 
able. 


90  NOTES    ON   NUESING. 

The  close  connection  between  ventilation  and  cleanli- 
ness is  sliown  in  this.  An  ordinary  light  paper  will  last 
clean  much  longer  if  there  is  an  Arnott's  ventilator  in 
the  chimney  than  it  otherwise  would. 

The  best  wall  now  extant  is  oil  paint.  From  this 
you  can  wash  the  animal  exuvia3.* 

These  are  what  make  a  room  musty. 
Best  kind  of         The  best  Wall  for  a  sick-room  or  ward  that  could  be 

wall  for  a  ^      .  ^  .  ^ 

sick-room,     made  IS  pure  white  non-absorbent  cement  or   glass,  or 
glazed  tiles,  if  they  were  made  sightly  enough. 

Air  can  be  soiled  just  like  water.  If  you  blow  into 
water  you  will  soil  it  with  the  animal  matter  from  your 
breath.  So  it  is  with  air.  Air  is  always  soiled  in  a  room 
where  walls  and  carpets  are  saturated  with  animal  exha- 
lations. 

"Want  of  cleanliness,  then,  in  rooms  and  wards,  which 
you  have  to  guard  against,  may  arise  in  three  ways. 

Dirty  air  1.  Dirty  air  comins:  in  from  without,  soiled  by  sewer 

from  with-  *'  n  -,  t 

out.  emanations,  the  evaporation  from  dirty  streets,  smoke, 

bits  of  unburnt  fuel,  bits  of  straw,  bits  of  horse  dung. 
Best  kind  of        If  people  would  but  covcr  the  outside  walls  of  their 

wall  for  a  •"•  _ 

house.  houses  with  plain  or  encaustic  tiles,  what  an  incalculable 

improvement  would  there  be  in  light,  cleanliness,  dry- 
ness, warmth,  and  consequently  economy.  The  play  of 
a  fire-engine  would  then  effectually  wash  the  outside  of  a 

children,   could  tell,  blindfold,  the  difference   of  the  air  in  old 

painted  and  in  old  papered  rooms,  cceteris  paribus.     The  latter 

will  always  be  dusty,  even  with  all  the  windows  open. 

How  to  keep        *  If  you  like  to  wipe  your  dirty  door,  or  some  portion  of  your 

ckan  at  the    dirty  wall,  by  hanging  up  your  clean  gown  or  shawl  against  it  on 

expense  of     ^  ^^^^  ^^^^  jg  ^^^  ^^y  certainly,   and  the  most  usual  way,  and 

clothes.  generally  the  only  way  of  cleaning  either  door  or  wall  in  a  bed 

room ! 


CLEANLINESS    OF   EOOMS   AND   WALLS.  91 

house.  This  kind  of  ivalUng  would  stand  next  to  paving 
in  improving  tlie  health  of  towns. 

2.  Dirty  air  cominsr  from  within,   from  dust,  which  pirty  air 

•^  °  ^  _  from  \vitliin. 

you  often  displace,  but  never  remove.  And  this  recalls 
what  ought  to  be  a  sine  qua  non.  Have  as  few  ledges 
in  your  room  or  ward  as  possible.  And  under  no  pre- 
tence have  any  ledge  whatever  out  of  sight.  Dust  ac- 
cumulates there,  and  will  never  be  wiped  off.  This  is  a 
certain  way  to  soil  the  air.  Besides  this,  the  animal  ex- 
halations from  your  inmates  saturate  your  furniture. 
And  if  you  never  clean  your  furniture  properly,  how  can 
your  rooms  or  wards  be  anything  but  musty  ?  Ventilate 
as  you  please,  the  rooms  w^ill  never  be  sweet.  Besides 
this,  there  is  a  constant  degradation,  as  it  is  called,  taking 
place  from  everything  except  polished  or  glazed  articles — 
E.  g.,  in  colouring  certain  green  papers  arsenic  is  used. 
Now  in  the  very  dust  even,  which  is  lying  about  in  rooms 
hung  with  this  kind  of  green  paper,  arsenic  has  been  dis- 
tinctly detected.  You  see  your  dust  is  anything  but 
harmless  ;  yet  you  will  let  such  dust  lie  about  your  ledges 
for  months,  your  rooms  for  ever. 

Again,  the  fire  fills  the  room  with  coal-dust. 

3.  Dirty  air  coming  from  the  carpet.     Above   all,  Birtyair 
take  care  of  the  carpets,  that  the  animal  dirt  left  there  carpet. 
by  the  feet  of  visitors  does  not  stay  there.     Floors,  unless 

the  grain  is  filled  up  and  polished,  are  just  as  bad.  The 
smell  from  the  floor  of  a  school-room  or  ward,  when  any 
moisture  brings  out  the  organic  matter  by  which  it  is 
saturated,  might  alone  be  enough  to  warn  us  of  the  mis- 
chief that  is  going  on. 

The  outer  air,  then,  can  only  be  kept  clean  by  sani-  Eemediea 
tary  improvements,  and  by  consuming  smoke.     The  ex- 


92  NOTES    ON   NUKSIXG. 

pense  in  soap,  which  this  single  improvement  would  save, 
is  quite  incalculable. 

The  inside  air  can  only  he  kept  clean  by  excesBive 
care  in  the  ways  mentioned  above — to  rid  the  walls,  car- 
pets, furniture,  ledges,  &c.,  of  the  organic  matter  and 
dust — dust  consisting  greatly  of  this  organic  matter — 
with  which  they  become  saturated,  and  which  is  what 
really  makes  the  room  musty. 

Without  cleanliness,  you  cannot  have  all  the  effect  of 
ventilation  ;  without  ventilation,  you  can  have  no 
thorough  cleanliness. 

Very  few  people,  be  they  of  what  class  they  may, 
have  any  idea  of  the  exquisite  cleanliness  required  in  the 
sick-room.  For  much  of  what  I  have  said  applies  less  to 
the  hospital  than  to  the  private  sick-room.  The  smoky 
chimney,  the  dusty  furniture,  the  utensils  emptied  but 
once  a  day,  often  keep  the  air  of  the  sick  constantly  dirty 
in  the  best  private  houses. 

The  well  have  a  curious  habit  of  forgetting  that  what 
is  to  them  but  a  trifling  inconvenience,  to  be  patiently 
*'  put  up  "  with,  is  to  the  sick  a  source  of  suffering,  delay- 
ing recovery,  if  not  actually  hastening  death.  The  well 
are  scarcely  ever  more  than  eight  hours,  at  most,  in  the 
same  room.  Some  change  they  can  always  make,  if  only 
for  a  few  minutes.  Even  during  the  supposed  eight 
hours,  they  can  change  their  posture  or  their  position  in 
the  room.  But  the  sick  man  who  never  leaves  his  bed, 
who  cannot  change  by  any  movement  of  his  own  his  air, 
or  his  light,  or  his  warmth ;  who  cannot  obtain  quiet,  or 
get  out  of  the  smoke,  or  the  smell,  or  the  dust ;  he  is 
really  poisoned  or  depressed  by  what  is  to  you  the  merest 
trifle. 

"  What  can't  be  cured  must  be  endured,"  is  the  very 


PERSONAL   CLEANLINESS.  93 

worst  and  most  dangerous  maxim  for  a  nurse  wliich  ever 
was  made.  Patience  and  resignation  in  her  are  but  other 
words  for  carelessness  or  indifference — contemptible,  if  in 
regard  to  herself;  culpable,  if  in  regard  to  her  sick. 


XL     PEflSONAL  CLEANLIXESS. 
In  almost  all   diseases,  the  function  of  the  skin  is,  Poisoning 

by  the  skin. 

more  or  less,  disordered  ;  and  in  many  most  important 
diseases  nature  relieves  herself  almost  entirely  by  the 
skin.  This  is  particularly  the  case  with  children.  But 
the  execretion,  which  comes  from  the  skin,  is  left  there, 
unless  removed  by  washing  or  by  the  clothes.  Every 
nurse  should  keep  this  fact  constantly  in  mind, — for,  if 
she  allow  her  sick  to  remain  unwashed,  or  their  cloth- 
ing to  remain  on  them  after  being  saturated  with  per- 
spiration or  other  excretion,  she  is  interfering  injuriously 
with  the  natural  processes  of  health  just  as  effectually  as  if 
she  were  to  give  the  patient  a  dose  of  slow  poison  by  the 
mouth.  Poisoning  by  the  skin  is  no  less  certain  than 
poisoning  by  the  mouth — only  it  is  slower  in  its  opera- 
tion. 

The  amount  of  relief  and  comfort  experienced  by  sick  ^^^fg^Jj*!.*'" 
after  the  skin  has  been  carefully  washed  and  dried,  is  one  cleanliness 

*'  '  equally  es- 

of  the  commonest  observations  made  at  a  sick  bed.  But  sentiai. 
it  must  not  be  forgotten  that  the  comfort  and  relief  so 
obtained  are  not  all.  They  are,  in  fact,  nothing  more 
than  a  sign  that  the  vital  powers  have  been  relieved  by 
removing  something  that  was  oppressing  them.  The 
nurse,  therefore,  must  never  put  off  attending  to  the  per- 
sonal cleanliness  of  her  patient  under  the  plea  that  all 
that  is  to  be  gained  is  a  little  relief,  which  can  be  quite 
as  well  given  later. 


»t  NOTICS    ON    M     K.S1N(J. 

ill  nil  wt'll-r(igiil;itc(l  liospiluls  tliis  ought  to  ])«•>  and 
p^onorally  is,  attoiulcd  to.  J  Jut  it  is  vury  ginicrjilly  lu'g- 
Icclcil  with  private  8iuk. 

.Just  iis  it  is  iiccessaiy  to  ri'iicw  llic  ;iir  loun-l  a  sick 
person  frequently,  to  eany  oil"  morhid  cllluviii  from  the 
lungs  and  skin,  by  maintaining  free  veutilatioii,  so  is  it 
necessary  to  keep  the  pores  of  the  skin  free  from  all  ob- 
Btrneting  cxeretions.  The  object,  both  of  ventilation  and 
of  skin-cleanliness,  is  j)retty  nmch  the  same, — to  wit, 
removing  noxious  inaUcr  from  \]u\  system  as  rapidly  as 
l)OSsil)h'. 

(.■are  should  be  taken  in  all  these  ()])erations  of  spong- 
ing, washing,  and  cleansing  the  skin,  not  to  expose  too 
great  a  sm-face  at  once,  so  as  to  check  tlie  perspiration, 
>vhich  would  renew  the  evil  in  another  form. 

Tlie  various  ways  of  washing  tlie  sick  need  not  here 
be  specified, — the  less  so  as  the  doctors  ought  to  say 
which  is  to  be  used. 

In  several  forms  of  di;irih(r;i,  dys(Milcry,  S:c.,  where 
the  skin  is  hard  and  liarsli,  llie  relief  allorded  hy  washing 
with  a  great  deal  of  soft  soa])  is  incalculable.  In  other 
cases,  sponging  with  tepid  soap  and  watc^r,  then  with 
tejtid  water  and  drying  with  a  hot.  towel  will  he  ordered. 

I'lvcu-y  nin-se  ought  to  be  careful  to  wash  her  hands 
very  fre([uently  during  the  day.  If  her  face  too,  so  nuieh 
the  better. 

One  word  as  to  cleanliness  merely  as  cleanliness, 
stoiiinini;  Cvoujpare  the  dirtiness  of  the   water   in   which   you 

"ho  ilkin.' "'^  have  washed  when  it.  is  vo]i\  without  soap,  cold  with 
soaj),  hot  with  soap.  Vou  will  iind  the  first  has  hardly 
removeil  any  dirt  at  all,  the  seci)nd  a  little  more,  the 
third  a  great  deal  more.  I'ut  hold  your  hand  over  a  cup 
of  hot  water  for  a  minute  or  two,  and    then,  by  merely 


ciiA  irioKiNt;    iiori'is   anm   advk'ios.  \}!i 

rul)l)iii<^^  wilii  llid  Wu'^vr,  you  will  l)rin;^^  oil'  IIuUch  of  diil, 
or  diil.y  Hkiii.  AflcM' a  v.-ipotir  hal.li  yon  miiy  peel  your 
Nvlioh;  Hfir  clean  in  IJiiH  vva,y.  Wlial,  I  uicui  is,  (lia.l,  hy 
Hiuiitly  wjisliiu;^'  or  Hpou;.;in;;  wilJi  wnlcr  you  (!(»  nol,  icilly 
clean  your  Hkin.  TuUo  u  rou^li  towel,  <li|)  one  coiik  r  in 
vi'iy  hot.  waliT,-  -ila,  lilllc!  Hpiiil-  \h)  inUU'.d  l.o  il,  il,  will  \m 
inori!  cHrcJ.u.il, — a-inl  (hen  rub  ji,h  if  you  wero  rul)l)inj^^  iJuj 
i()VV(!l  inl.o  your  Hkin  willi  your  lin;;;crH.  'i'lie  bluck  lljik(!H 
\vlii«li  will  (•,otU(!  (.11' will  convince  you  liiat,  you  were  nol, 
clc'in  hcforo,  however  niucli  soap  and  waier  you  liaA'o 
nsed.  'IMieH(i  ihlki'.H  are  wlial,  rc(piire  rcniovin,";.  And 
you  can  ii'a.ily  keep  yourself  rlc.-iiier  wilJi  a,  l,und»ler  oi" 
Iiol,  wal(!r  and  a  rou;di  l.oucl  and  ruMiinj',,  llian  with  a, 
whole,  a,pj»ara,lus  oi'  ha.lli  and  soaj*  and  spoii;';e,  williout. 
ruhhin;^:.  Il,  Ih  (piil.o  iionHeuHe  l.o  Ha,y  thai,  anybody  iwrA 
be  dirl.y.  l*a,t,ieiil,H  hav(^  heeii  ke|)l,  as  <lean  hy  l,heH<5 
iuea,ns  on  a,  Ion;j^  voya,;.';e,  when  a,  ha^in  lid!  ol  waler 
could  nol,  he  a,l)'orded,  and  when  l.liey  could  nol,  he  niovc^d 
oul,  of  l.heir  herlliH,  as  If  a,ll  l,h(!  a,ppurl,eii;ince.H  i)\'  lioiud 
ha.d  hern  at  ha.nd. 

VVa,Hhin^S  however,  with  a  hirjj;*',  <pia,nlily  of  water 
has  (|ult(?  other  cU'eetH  tha,n  those  of  nuu'e  (deanline.HH. 
'I'he  skin  a,hsoih,s  the  wa,(erand  he<-onieM  sol'lcr  and  nioie 
I)(!rHj)irahh!.  'i'o  wa,Hli  with  Hoa,p  a,n<l  Hol't  w;it«M-  is,  IIhuc- 
f()r(!,  denirahltj  I'roui  other  pointH  of  view  than  that  ol" 
cieanlincKH. 


XII.    CIIATTCIMN*;    IIOIMIS    AND    ADVK'KH. 

'I'Ik!  Hick  ina,n  to  his  adviH«',rH.  A.tvl«lfi(jMiM 

"  My  adviHcu's!      TlHur  na,rrM;  is  le;non.        ''''        '^ 
Somehow  or  oMi(!r,  it   seeuiH  a,    provision  of  the  iiiiiv<'rHal 


90  I^OTKS    ON    NUJISING. 

destinies,  lliaL  every  man,  woman,  and  cliild  should  con- 
sider him,  her,  or  itself  privileged  especially  to  advise 
mc.  Wliy  ?  That  is  precisely  wliat  1  want  to  know." 
And  this  is  what  I  have  to  say  to  them.  1  have  been 
advised  to  go  to  every  place  extant  in  and  out  of  Eng- 
land— to  take  every  kind  of  exercise  hy  every  kind  of 
cart,  carriage — yes,  and  even  swing  (!)  and  dumb-bell  (!) 
in  existence ;  to  imbibe  every  different  kind  of  stimulus 
that  ever  has  been  invented.  And  this  when  those  best 
fitted  to  know,  viz.,  medical  men,  after  long  and  close  at- 
tenihince,  had  declared  any  journey  out  of  the  question, 
bad  i)i()hibitcd  any  kind  of  motion  whatever,  had  closely 
laid  ilown  the  diet  and  drink.  AV'hat  would  my  advisers 
say,  were  they  the  medical  attendants,  and  I  the  patient 
left  their  advice,  and  took  the  casual  adviser's?  But  the 
singularity  in  Legion's  mind  is  this:  it  never  occurs  to 
him  that  everybody  else  is  doing  the  same  thing,  and 
that  1  the  })atient  must  j)erforce  say,  in  sheer  self-de- 
fence, like  liosalind,  "■  I  could  not  do  with  all." 

rimttoriiiK  "  Chattering  Hopes "    may  seem  an   odd   heading. 

i.iiMooitiio  J)ut  I  really  believe  there  is  scarcely  a  greater  worry 
which  invalids  have  to  endure  than  the  incurable  hopes 
of  their  friends.  There  is  no  one  practice  against  which 
I  can  speak  more  strongly  from  actual  personal  expe- 
rience, wide  and  long,  of  its  effects  during  sickness  ob- 
served both  upon  others  and  upon  myself.  I  would  ap- 
peal most  seriously  to  all  friends,  visitors,  and  attendants 
of  the  sick  to  leave  off  this  practice  of  attempting  to 
"cheer"  the  sick  by  making  light  of  their  danger  and 
by  exaggerating  their  probabilities  of  recovery. 

Far  more  now  than  formerly  does  the  medical  at- 
tendant tell  the  truth  to  the  sick  who  are  really  desirous 
to  hear  it  about  their  own  state. 


(•iiA'iTi:Ki.N<i   ih>n:s  and  ai»\hi:s.  1)7 

How  iiil()ns(!  is  \\ui  folly,  then,  to  Ray  tlui  IcuhI  of  i(, 
of  tlio  friend,  l)o  lie  even  n  iiiedicul  niuii,  who  thinkn 
lii.il,  his  opinion,  ^;iv<  u  ulYcr  a  cursory  ohservation,  will 
wei;^h  wil.h  the  pulieni,  u^^aiiist  the  opinion  of  tln'  med- 
ical Htt(^ndant,  f^iven,  j»erha[)H,  al'ter  years  of  ohserval  ion, 
after  usin«^  evcsry  helj)  lo  diagnosis  alforded  l>y  lh(!  stetho- 
ficope,  the  exaniinalion  of  pulse,  ton^^'Ue,  Ac;  and  ecr- 
tainly  after  uiufh  more  ohservatlon  tha,u  Ihi-  friend  can 
possihly  hav(!  ha,d. 

Supj)osiu^  th(5  patient  to  he  possesse<l  of  common 
sense, — how  can  tlie  "  l.uouiahh' "  (tpinion,  it  it  is  to  he 
ealled  an  opinion  at  all,  of  tlu;  casual  visit,or  "  cheiu*  " 
him, — when  dillerent  from  that  of  the  experienced 
at.tcndaiit,  ^  Unijuesl  ionahly  1  hi^  laltcr  nia.y,  and  often 
do(!S,  turn  out,  to  he  wroii;.';.  Hut  wliich  is  most  likely  to 
bo  wron«,^/  ,,  ,,    ,  , 

'^  rail. •111.  (loui 

'rhe  fact  is,  that  the  patient*  is  not  ''cheered"  at  all  i-i  NV'i"i  i.. 

'  '  talk  olliliii- 

*  Tlierci    iU'e,  of  courHC,  cariOH,  as  in   lirsl,  coiiliiiciiu'iils,  wImm   AliMnnl  hla- 
uik  assunuKM!  lioin  the  doctor  or  experieiuu-d   iiuihu  to  tlu!  lri;^lit-  pmiNoiis 
ciiod  HiiHt'riii^  woman  that  there   in  nothing  iintiHiial  in  licr  cano,  """'"  '" 
tliat  hIio  hart  uotliin;;  to  fear  but  a  low  hoiirM*  |)ain,  may  chtM-r  her  <'oiiviimii(I.iii 
most  oiroetually.     Thin  is   advice*  ol"  (|uitn  anothc-r  order.     It  in  h',^i,«i'i',i,'.'r,r<.. 
tho  advitui  of  exrxiricnco  to    iiMcf   imxini  iiucc.      Hut  tiw  advi(!r  I''"  'VA    I" 
wo  have  been  reterrinj^  to  is  tin-   ndviii-  of  incxpciicncr  to  bitlcr  ni.w,l.k. 
experience;  and,  in  ^eniMid,  anKiuntM  lo  iioiliin;-  inuic  tlian  ilii  i, 
that  you  think  J  Hinill   recovi  r   IVoni   cnii,iiiii|.l  ion   hettmiMt!  Honn;- 
body  l<nowH  Homebody  Hoincwhcic  wlu.  h.iM  rccov(M'ed  from  fever. 

i  hav(!  heard  a  doctor  condemned  whos<;  piitient  did  not,  alas  I 
recover,  because  anotlier  doctor's  patient  of  a  di(/'n'i')U  sex,  of  a 
dij/'ertut  a^o,  recovcrt-d  from  a  (lij/'erunt  diseaHe,  in  a  different 
place.  Yes,  this  is  really  trno.  If  jjeophs  who  make  these  com- 
parisons did  l)nt  know  (only  they  do  not  care  to  know),  tli(*  care 
und  pr(!cisencHS  with  which  hiicIi  (MxnpariHoiiN  rcipiire  to  be  made, 
(and  an;  made,)  in  order  to  be  (»f  any  Viihic  whatever,  they  wonld 
Hpare   their  tongues,     in   conipaiing   the  ilcuths  of  om;  hospital 


98  NOTES    OX   NURSING. 

by  these  well-meaning,  most  tiresome  friends.  On  the 
contrary,  lie  is  depressed  and  wearied.  If,  on  the  one 
hand,  he  exerts  himself  to  tell  each  successive  member 
of  this  too  numerous  conspiracy,  whose  name  is  legion, 
why  he  does  not  think  as  they  do, — in  what  respect  he 
is  worse, — what  symptoms  exist  that  they  know  nothing 
of, — he  is  fatigued  instead  of  "  cheered,"  and  his  atten- 
tion is  fixed  upon  himself.  In  general,  patients  who  are 
really  ill,  do  not  want  to  talk  about  themselves.  Hypo- 
chondriacs do,  but  again  I  say  we  are  not  on  the  subject 
of  hypochondriacs. 
^kSons^put  ^^'  ^^  ^®  other  hand,  and  which  is  much  more  fre- 
benefit'of^^  quently  the  case,  the  patient  says  nothing,  but  the 
the  sick.  Shakespearian  "  Oh  !  "  "  Ah !  "  "  Go  to !  "  and  "  In  good 
sooth  !  "  in  order  to  escape  from  the  conversation  about 
himself  the  sooner,  he  is  depressed  by  want  of  sympathy. 
He  feels  isolated  in  the  midst  of  friends.  He  feels  what 
a  convenience  it  would  be,  if  there  were  any  single  per- 
son to  whom  he  could  speak  simply  and  openly,  without 
pulling  the  string  upon  himself  of  this  shower-bath  of 
silly  hopes  and  encouragements ;  to  whom  he  could  ex- 
press his  wishes  and  directions  without  that  person  per- 
sisting in  saying,  "  I  hope  that  it  will  please  God  yet  to 
give  you  twenty  years,"  or,  "  You  have  a  long  life  of 
activity  before  you."     How  often  we  see  at  the  end  of 

with  those  of  another,  any  statistics  are  justly  considered  abso- 
lutely valueless  which  do  not  give  the  ages,  the  sexes,  and  the 
diseases  of  all  the  cases.  It  does  not  seem  necessary  to  mention 
this.  It  does  not  seem  necessary  to  say  that  there  can  be  no 
comparison  between  old  men  with  dropsies  and  young  women 
with  consumptions.  Yet  the  cleverest  men  and  the  cleverest 
women  are  often  heard  making  such  comparisons,  ignoring  entirely 
sex,  age,  disease,  place — in  fact,  all  the  conditions  essential  to  the 
question.     It  is  the  merest  gossip. 


CHATTERINO    HOPES    AND    ADVICES.  99 

biographies  or  of  cases  recorded  in  medical  papers,  "  after 
a  long  illness  A.  died  rather  suddenly,"  or,  "  unex- 
pectedly both  to  himself  and  to  others."  "  Unexpected- 
ly "  to  others,  perhaps,  who  did  not  see,  because  they  did 
not  look  ;  but  by  no  means  "  unexpectedly  to  himself," 
as  I  feel  entitled  to  believe,  both  from  the  internal  evi- 
dence in  such  stories,  and  from  watching  similar  cases ; 
there  was  every  reason  to  expect  that  A.  would  die,  and 
he  knew  it ;  but  he  found  it  useless  to  insist  upon  his  own 
knowledge  to  his  friends. 

In  these  remarks  I  am  alluding  neither  to  acute  cases 
which  terminate  rapidly  nor  to  "  nervous  "  cases. 

By  the  first  much  interest  in  their  own  danger  is 
very  rarely  felt.  In  writings  of  fiction,  whether  novels 
or  biographies,  these  death-beds  are  generally  depicted  as 
almost  seraphic  in  lucidity  of  intelligence.  Sadly  large 
has  been  my  experience  in  death-beds,  and  I  can  only 
say  that  I  have  seldom  or  never  seen  such.  Indifference, 
excepting  with  regard  to  bodily  suffering,  or  to  some 
duty  the  dying  man  desires  to  jjerform,  is  the  far  more 
usual  state. 

The  "  nervous  case,"  on  the  other  hand,  delights  in 
figuring  to  himself  and  others  a  fictitious  danger. 

But  the  long  chronic  case,  who  knows  too  well  him- 
self, and  who  has  been  told  by  his  physician  that  he  will 
never  enter  active  life  again,  who  feels  that  every  month 
he  has  to  give  up  something  he  could  do  the  month  be- 
fore— oh !  spare  such  sufferers  your  chattering  hopes. 
You  do  not  know  how  you  worry  and  weary  them.  Such 
real  sufferers  cannot  bear  to  talk  of  themselves,  still  less 
to  hope  for  what  they  cannot  at  all  expect. 

So  also  as  to  all  the  advice  showered  so  profusely 
upon  such  sick,  to  leave  off  some  occupation,  to  try  some 


100  NOTES    ON    XUKSING. 

other  doctor,  some  other  house,  climate,  pill,  powder,  or 
specific  ;  I  say  nothing  of  the  inconsistency — for  these 
advisers  are  sure  to  be  the  same  persons  who  exhorted 
the  sick  man  not  to  believe  his  own  doctor's  prognostics, 
because  "doctors  are  always  mistaken,"  but  to  believe 
some  other  doctor,  because  "  this  doctor  is  always  right." 
Sure  also  are  these  advisers  to  be  the  persons  to  bring  the 
sick  man  fresh  occupation,  while  exhorting  him  to  leave 
his  own. 
Wonderful  Woudcrful   is  the  face  with  which  friends,  lay  and 

presumption  -,.      -,        -t,  .  i  •  •  -, 

of  the  ad-      mcdical.  Will  comc  m  and  worry  the  patient  with  recom- 

visers  of  the  .  ,  ,        .  .  ,. 

sick.  mendations  to  do  something  or  other,  having  just  as  lit- 

tle knowledge  as  to  its  being  feasible,  or  even  safe  for 
him,  as  if  they  were  to  recommend  a  man  to  take  exer- 
cise, not  knowing  he  had  broken  his  leg.  What  would 
the  friend  say,  if  he  were  the  medical  attendant,  and  if 
the  patient,  because  some  other  friend  had  come  in,  be- 
cause somebody,  anybody,  nobody,  had  recommended 
something,  anything,  nothing,  were  to  disregard  his 
orders,  and  take  that  other  body's  recommendation  1  But 
people  never  think  of  this. 

Advisers  the         j^   celebrated  historical    personaore   has  related  the 

same  now  as  l  >=> 

two  hundred  commonplaces  which,  when  on  the  eve  of  executing  a 

years  ago,  -^  '  ^  ° 

remarkable  resolution,  were  showered  in  nearly  the  same 
words  by  every  one  around  successively  for  a  period  of 
six  months.  To  these  the  personage  states  that  it  was 
found  least  trouble  always  to  reply  the  same  thing,  viz., 
that  it  could  not  be  supposed  that  such  a  resolution  had 
been  taken  without  sufficient  previous  consideration.  To 
patients  enduring  every  day  for  years  from  every  friend 
or  acquaintance,  either  by  letter  or  viva  voce,  some  tor- 
ment of  this  kind,  I  would  suggest  the  same  answer.  It 
would  indeed  be  spared,  if  such  friends  and  acquaintances 


CHATTEllING    HOPES    AND    ADVICES.  101 

would  but  consider  for  one  moment,  that  it  is  probable 
the  patient  has  heard  such  advice  at  least  fifty  times  be- 
fore, and  that,  had  it  been  practicable,  it  would  have  been 
practised  long  ago.  But  of  such  consideration  there  ap- 
pears to  be  no  chance.  Strange,  though  true,  that  peo- 
ple should  be  just  the  same  in  these  things  as  they  were 
a  few  hundred  years  ago  ! 

To  me  these  commonplaces,  leaving  their  smear  upon 
the  cheerful,  single-hearted,  constant  devotion  to  duty, 
which  is  so  often  seen  in  the  decline  of  such  sufferers, 
recall  the  slimy  trail  left  by  the  snail  on  the  sunny 
southern  garden-wall  loaded  with  fruit. 

No  mockery  in  the  world  is  so  hollow  as  the  advice  Mockery  of 

*'  the  advice 

showered  upon  the  sick.     It  is  of  no  use  for  the  sick  to  given  to 

,  sick. 

say  anything,  for  what  the  adviser  wants  is,  not  to  know 
the  truth  about  the  state  of  the  patient,  but  to  turn 
whatever  the  sick  may  say  to  the  support  of  his  own  ar- 
gument, set  forth,  it  must  be  repeated,  without  any  in- 
quiry whatever  into  the  patient's  real  condition.  "  But 
it  would  be  impertinent  or  indecent  in  me  to  make  such 
an  inquiry,"  says  the  adviser.  True ;  and  how  much 
more  impertinent  is  it  to  give  your  advice  when  you  can 
know  nothing  about  the  truth,  and  admit  you  could  not 
inquire  into  it. 

To  nurses  I  say — these  are  the  visitors  who  do  your 
patient  harm.  AVhen  you  hear  him  told: — 1.  That  he 
has  nothing  the  matter  with  him,  and  that  he  wants 
cheering.  2.  That  he  is  committing  suicide,  and  that 
he  wants  preventing.  3.  That  he  is  the  tool  of  some- 
body who  makes  use  of  him  for  a  purpose.  4.  That  he 
will  listen  to  nobody,  but  is  obstinately  bent  upon  his 
own  way ;  and  o.  That  he  ought  to  be  called  to  a  sense 
of  duty,  and  is  flying  in  the  face  of  Providence ; — then 


102  NOTES    ON   NURSING. 

know  that  your  patient  is  receiving  all   the  injury  that 
he  can  receive  from  a  visitor. 

How  little  the  real  sufiferings  of  illness  are  known  or 
understood.     How  little  does  any  one  in  good  health 
fancy  him  or  even  herself  into  the  life  of  a  sick  person. 
Means  of  j)^  „q^  ^^j^q  ^j.g  about  the  sick  or  who  visit  the  sick. 

giving  plea-  '  -^  -' 

sure  to  the  ^^.j  ^nd  give  them  pleasure,  remember  to  tell  them  what 
will  do  so.  How  often  in  such  ^dsits  the  sick  person  has 
to  do  the  whole  conversation,  exerting  his  own  imagina- 
tion and  memory,  while  you  would  take  the  visitor,  ab- 
sorbed in  his  own  anxieties,  making  no  effort  of  memory 
or  imagination,  for  the  sick  person.  "  Oh !  my  dear,  I 
have  so  much  to  think  of,  I  really  quite  forgot  to  tell 
him  that ;  besides,  I  thought  he  would  know  it,"  says 
the  visitor  to  another  friend.  How  could  "  he  know  it  ?  '* 
Depend  upon  it,  the  people  who  say  this  are  really  those 
who  have  little  "  to  think  of."  There  are  many  burthened 
w  ith  business  who  always  manage  to  keep  a  pigeon-hole 
in  their  minds,  full  of  things  to  tell  the  "  invalid." 

I  do  not  say,  don't  tell  him  your  anxieties — I  believe 
it  is  good  for  him  and  good  for  you  too ;  but  if  you  tell 
him  what  is  anxious,  surely  you  can  remember  to  tell  him 
what  is  pleasant  too. 

A  sick  person  does  so  enjoy  hearing  good  news  : — 
for  instance,  of  a  love  and  courtship,  while  in  progress 
to  a  good  ending.  If  you  tell  him  only  when  the  mar- 
riage takes  place,  he  loses  half  the  pleasure,  which  God 
knows  he  has  little  enough  of;  and  ten  to  one  but  you 
have  told  him  of  some  love-making  with  a  bad  ending. 

A  sick  person  also  intensely  enjoys  hearing  of  any 
material  good,  any  positive  or  practical  success  of  the 
right.  He  has  so  much  of  books  and  fiction,  of  princi- 
ples, and  precepts,  and  theories  ;  do,  instead  of  advising 


CHATTERING   HOPES    AND   ADVICES.  103 

him  with  advice  he  has  heard  at  least  fifty  times  before, 
tell  him  of  one  benevolent  act  which  has  really  succeeded 
practically, — it  is  like  a  day's  health  to  him.* 

You  have  no  idea  what  the  craving  of  sick  with  un- 
diminished power  of  thinking,  but  little  power  of  doing, 
is  to  hear  of  good  practical  action,  when  they  can  no 
longer  partake  in  it. 

Do  observe  these  things  with  the  sick.  Do  remember 
how  their  life  is  to  them  disappointed  and  incomplete. 
You  see  them  lying  there  with  miserable  disappoint- 
ments, from  which  they  can  have  no  escape  but  death, 
and  you  can't  remember  to  tell  them  of  what  would 
give  them  so  much  pleasure,  or  at  least  an  hour's  va- 
riety. 

They  don't  want  you  to  be  lachrymose  and  whining 
with  them,  they  like  you  to  be  fresh  and  active  and  in- 
terested, but  they  cannot  bear  absence  of  mind,  and  they 
are  so  tired  of  the  advice  and  preaching  they  receive  from 
everybody,  no  matter  whom  it  is,  they  see. 

There  is  no  better  society  than  babies  and  sick 
people  for  one  another.  Of  course  you  must  manage 
this  so  that  neither  shall  suffer  from  it,  which  is  per- 
fectly possible.  If  you  think  the  "  air  of  the  sick  room  " 
bad  for  the  baby,  why  it  is  bad  for  the  invalid  too,  and, 
therefore,  you  will  of  course  correct  it  for  both.  It 
freshens  up  a  sick  person's  whole  mental  atmosphere  to 
see  "  the  baby."  And  a  very  young  child,  if  unspoiled, 
will  generally  adapt  itself  wonderfully  to  the  ways  of  a 

*  A  small  pet  animal  is  often  an  excellent  companion  for  the 
sick,  for  long  chronic  cases  especially.  A  pet  bird  in  a  cage  is 
sometimes  the  only  pleasure  of  an  invalid  confined  for  years  to 
the  same  room.  If  he  can  feed  and  clean  the  animal  himself,  he 
ought  always  to  be  encouraged  to  do  so. 


104  NOTES   ON   NUESING. 

sick  person,  if  the  time  they  spend  together  is  not  too 
long. 

If  you  knew  how  unreasonably  sick  people  suffer 
from  reasonable  causes  of  distress,  you  would  tuke  more 
pains  about  all  these  things.  An  infant  laid  upon  the  sick 
bed  will  do  the  sick  person,  thus  suffering,  more  good 
than  all  your  logic.  A  piece  of  good  news  will  do  the 
same.  Perhaps  you  are  afraid  of  "disturbing"  him. 
You  say  there  is  no  comfort  for  his  present  cause  of  af- 
fliction. It  is  perfectly  reasonable.  The  distinction  is 
this,  if  he  is  obliged  to  act,  do  not  "  disturb  "  him  with 
another  subject  of  thought  just  yet ;  help  him  to  do  what 
he  wants  to  do ;  but,  if  he  has  done  this,  or  if  nothing 
can  be  done,  then  "  disturb  "  him  by  all  means.  You  will 
relieve,  more  effectually,  unreasonable  suffering  from  rea- 
sonable causes  by  telling  him  "  the  news,"  showing  him 
*'  the  baby,"  or  giving  him  something  new  to  think  of 
or  to  look  at  than  by  all  the  logic  in  the  world. 

It  has  been  very  justly  said  that  the  sick  are  like 
children  in  this,  that  there  is  no  'projportion  in  events  to 
them.  Now  it  is  your  business  as  their  visitor  to  restore 
this  right  proportion  for  them — to  show  them  what  the 
rest  of  the  world  is  doing.  How  can  they  find  it  out 
otherwise  %  You  will  find  them  far  more  open  to  convic- 
tion than  children  in  this.  And  you  wiU  find  that  their 
unreasonable  intensity  of  suffering  from  unkindness,  from 
want  of  sympathy,  &c.,  will  disappear  with  their  freshened 
interest  in  the  big  world's  events.  But  then  you  must 
be  able  to  give  them  real  interests,  not  gossip. 

Two  new  XoTE. — There  are  two  classes  of  patients  which  are  unfortu- 

patients  pe-    nately   becoming  more   common   every    day,    especially   among 

culiar  to  this  -women  of  the  richer  orders,  to  whom  all  these  remarks  are  pre- 
generation.  '  '^ 

eminently  inapplicable.     1.  Those  who  make  health  an  excuse 


OBSEKVATION    OF   THE   SICK.  105 

for  doing  nothing,  and  at  the  same  time  allege  that  the  being  able 
to  do  nothing  is  their  only  grief.  2.  Those  who  have  brought 
upon  themselves  ill-health  by  over  pursuit  of  amusement,  which 
they  and  their  friends  have  most  unhappily  called  intellectual 
activity.  I  scarcely  know  a  greater  injury  that  can  be  inflicted 
than  the  advice  too  often  given  to  the  first  class  to  "  vegetate" — 
or  than  the  admiration  too  often  bestowed  on  the  latter  class  for 
"  pluck." 


XIII.    OBSERVATION   OF   THE   SICK. 

There  is  no  more  silly  or  universal  question  scarcely  ^^^^  ^^j^g^® 
asked  than  this,  "  Is  he  better?  "    Ask  it  of  the  medical  q^^r^tion,  is 

'  _        he  better  i 

attendant,  if  you  please.  But  of  whom  else,  if  you  wish 
for  a  real  answer  to  your  question,  would  you  ask  %  Cer- 
tainly not  of  the  casual  visitor  ;  certainly  not  of  the  nurse, 
while  the  nurse's  observation  is  so  little  exercised  as  it  is 
now.  What  you  want  are  facts,  not  opinions — for  who 
can  have  any  opinion  of  any  value  as  to  whether  the  pa- 
tient is  better  or  worse,  excepting  the  constant  medical 
attendant,  or  the  really  observing  nurse  ? 

The  most  important  practical  lesson  that  can  be  given 
to  nurses  is  to  teach  them  what  to  observe — how  to  ob- 
serve— what  symptoms  indicate  improvement — ^what  the 
reverse — which  are  of  importance — which  are  of  none — 
which  are  the  evidence  of  neglect — and  of  what  kind  of 
neglect. 

All  this  is  what  ought  to  make  part,  and  an  essential 
part,  of  the  training  of  every  nurse.  At  present  how  few 
there  are,  either  professional  or  unprofessional,  who  really 
know  at  all  whether  any  sick  person  they  may  be  with  is 
better  or  worse. 

The  vagueness  and  looseness  of  the  information  one 
receives  in  answer  to  that  much  abased  question,  "  Is  he 
5* 


106  NOTES    ON   NUKSING. 

better  ^  "  would  be  ludicrous,  if  it  were  not  painful.  The 
only  sensible  answer  (in  the  present  state  of  knowledge 
about  sickness)  would  be  "  How  can  I  know?  I  cannot 
tell  how  he  was  when  I  was  not  with  him." 

I  can  record  but  a  very  few  specimens  of  the  answers  * 

*  It  is  a  much  more  difficult  thing  to  speak  the  truth  than 
people  commonly  imagine.  There  is  the  want  of  observation 
simple^  and  the  want  of  observation  compound^  compounded,  that 
is,  with  the  imaginative  faculty.  Both  may  equally  intend  to 
speak  the  truth.  The  information  of  the  first  is  simply  defective. 
That  of  the  second  is  much  more  dangerous.  The  first  gives,  in 
answer  to  a  question  asked  about  a  thing  that  has  been  before  his 
eyes  perhaps  for  years,  information  exceedingly  imperfect,  or  says, 
he  does  not  know.  He  has  never  observed.  And  people  simply 
think  him  stupid. 

The  second  has  observed  just  as  little,  but  imagination  im- 
mediately steps  in,  and  he  describes  the  whole  thing  from  imagi- 
nation merely,  being  perfectly  convinced  all  the  while  that  he  has 
Been  or  heard  it ;  or  he  will  repeat  a  whole  conversation,  as  if  it 
were  information  which  had  been  addressed  to  him  ;  whereas  it  is 
merely  what  he  has  himself  said  to  somebody  else.  This  is  the 
commonest  of  all.  These  people  do  not  even  observe  that  they 
have  not  observed,  nor  remember  that  they  have  forgotten. 

Courts  of  justice  seem  to  think  that  anybody  can  speak  "the 
whole  truth,  and  nothing  but  the  truth,"  if  he  does  but  intend 
it.  It  requires  many  faculties  combined  of  observation  and  mem- 
ory to  speak  "  the  whole  truth,"  and  to  say  "  nothing  but  the 
truth." 

"I  knows  I  fibs  dreadful;  but  believe  me.  Miss,  I  never  finds 
out  I  have  fibbed  until  they  tells  me  so,"  Avas  a  remark  actually 
made.  It  is  also  one  of  much  more  extended  application  than 
most  people  have  the  least  idea  of. 

Concurrence  of  testimony,  which  is  so  often  adduced  as  final 
proof,  may  prove  nothing  more,  as  is  well  known  to  those  accus- 
tomed to  deal  with  the  unobservant  imaginative,  than  that  one 
person  has  told  his  story  a  great  many  times. 

I  have  heard  thirteen  persons  "concur"  in  declaring  that  a 


OBSERVATION   OF   THE   SICK.  107 

which  I  have  heard  made  by  friends  and  nurses,  and  ac- 
cepted by  physicians  and  surgeons  at  the  very  bed-side 
of  the  patient,  who  could  have  contradicted  every  word, 
but  did  not — sometimes  from  amiability,  often  from  shy- 
ness, oftenest  from  languor ! 

"  How  often  have  the  bowels  acted,  nurse  ?  "  "  Once, 
sir."  This  generally  means  that  the  utensil  has  been 
emptied  once,  it  having  been  used  perhaps  seven  or  eight 
times. 

"  Do  you  think  the  patient  is  much  weaker  than  he 
was  six  weeks  ago  ?  "  "Oh  no,  sir  ;  you  know  it  is  very 
long  since  he  has  been  up  and  dressed,  and  he  can  get 
across  the  room  now."  This  means  that  the  nurse  has 
not  observed  that  whereas  six  weeks  ago  he  sat  up  and 
occupied  himself  in  bed,  he  now  lies  still  doing  nothing  ; 
that,  although  he  can  "  get  across  the  room,"  he  cannot 
stand  for  five  seconds. 

Another  patient  who  is  eating  well,  recovering  stead- 
ily, although  slowly,  from  fever,  but  cannot  walk  or 
stand,  is  represented  to  the  doctor  as  making  no  progress 
at  all. 

Questions,  too,  as  asked  now  (but  too  generally)  of  or  J'ueftiols 
about  patients,  would  obtain  no  information  at  all  about  "seiess  or 

•*•  '  misleading. 

them,  even  if  the  person  asked  of  had  every  information 

fourteenth,  who  had  never  left  his  bed,  went  to  a  distant  chapel 
every  morning  at  seven  o'clock. 

I  have  heard  persons  in  perfect  good  faith  declare,  that  a  man 
came  to  dine  every  day  at  the  house  where  they  lived,  who  had 
never  dined  there  once  ;  that  a  person  had  never  taken  the  sacra- 
ment, by  whose  side  they  had  twice  at  least  knelt  at  Communion  ; 
that  but  one  meal  a  day  came  out  of  a  hospital  kitchen,  which 
for  six  weeks  they  had  seen  provide  from  three  to  five  and  six 
meals  a  day.  Such  instances  might  be  multiplied  ad  infinitum  if 
necessary. 


108  NOTES    OX   NUESING. 

to  give.  The  question  is  generally  a  leading  question  ; 
and  it  is  singular  that  people  never  think  what  must  be 
the  answer  to  this  question  before  they  ask  it :  for  in- 
stance, "  Has  he  had  a  good  night  ?  "  Now,  one  patient 
will  think  he  has  a  bad  night  if  he  has  not  slept  ten 
hours  without  waking.  Another  does  not  think  he  has 
a  bad  night  if  he  has  had  intervals  of  dosing  occasionally. 
The  same  answer  has  actually  been  given  as  regarded 
two  patients — one  who  had  been  entirely  sleepless  for 
five  times  twenty-four  hours,  and  died  of  it,  and  another 
who  had  not  slept  the  sleep  of  a  regular  night,  without 
waking.     Why  cannot  the  question  be  asked,  How  many 

hours'  sleep  has had  ?  and  at  what  hours  of  the 

night  1  *  "I  have  never  closed  my  eyes  all  night,"  an 
answer  as  frequently  made  when  the  speaker  has  had 
Beveral  hours'  sleep  as  when  he  has  had  none,  would  then 
be  less  often  said.  Lies,  intentional  and  unintentional, 
are  much  seldomer  told  in  answer  to  precise  than  to 
leading  questions.  Another  frequent  error  is  to  inquire 
whether  one  cause  remains,  and  not  whether  the  effect 
which  may  be  produced  by  a  great  mauy  different  causes, 
Qiot  inquired  after,  remains.  As  when  it  is  asked, 
whether  there  was  noise  in  the  street  last  night ;  and  if 
there  were  not,  the  patient  is  reported,  without  more 
ado,  to  have  had  a  good  night.  Patients  are  completely 
taken   aback  by  these  kinds  of  leading  questions,  and 

*  This  is  important,  because  on  this  depends  what  the  remedy 
will  be.  If  a  patient  sleeps  two  or  three  hours  early  in  the  night, 
and  then  does  not  sleep  again  at  all,  ten  to  one  it  is  not  a  narcotic 
he  wants,  but  food  or  stimulus,  or  perhaps  only  warmth.  If,  on 
the  other  hand,  he  is  restless  and  awake  all  night,  and  is  drowsy 
in  the  morning,  he  probably  wants  sedatives,  either  quiet,  cool- 
ness, or  medicine,  a  lighter  diet,  or  all  four.  Now  the  doctor 
should  be  told  this,  or  how  can  he  judge  what  to  give  ? 


OBSERVATION    OF   THE   SICK.  109 

give  only  the  exact  amount  of  information  asked  for,  even 
when  they  know  it  to  be  completely  misleading.  The 
shyness  of  patients  is  seldom  allowed  for. 

How  few  there  are  who,  by  five  or  six  pointed  ques- 
tions, can  elicit  the  whole  case,  and  get  accurately  to 
know  and  to  be  able  to  report  lohere  the  patient  is. 

I  knew  a  very  clever  physician,  of  large  dispensary  Jffn-"ngfn?^ 
and  hospital  practice,  who  invariably  began  his  examina-  Jy^mSion"' 
tion  of  each  patient  with  "  Put  your  finger  where  you  be 
bad."     That  man  would  never  waste  his  time  with  col- 
lecting  inaccurate    information  from   nurse  or  patient. 
Leading  questions  always  collect  inaccurate  information. 

At  a  recent  celebrated  trial,  the  following  leading 
question  was  put  successively  to  nine  distinguished  med- 
ical men.  "  Can  you  attribute  these  symptoms  to  any- 
thing else  but  poison  ?  "  And  out  of  the  nine,  eight  an- 
swered "  No  !  "  without  any  qualification  whatever.  It 
appeared,  upon  cross-examination  : — 1.  That  none  of 
them  had  ever  seen  a  case  of  the  kind  of  poisoning  sup- 
posed. 2.  That  none  of  them  had  ever  seen  a  case  of 
the  kind  of  disease  to  which  the  death,  if  not  to  poison, 
was  attributable.  3.  That  none  of  them  were  even  aware 
of  the  main  fact  of  the  disease  and  condition  to  which  the 
death  was  attributable. 

Surely  nothing  stronger  can  be  adduced  to  prove 
what  use  leading  questions  are  of,  and  what  they  lead 
to. 

I  had  rather  not  say  how  many  instances  I  have 
known,  where,  owing  to  this  system  of  leading  questions, 
the  patient  has  died,  and  the  attendants  have  been  ac 
tually  unaware  of  the  principal  feature  of  the  case. 

It  is  useless  to  go  through  all  the  particulars,  besides  "We^nuaLi 
sleep,  in  which  people  have  a  peculiar  talent  for  gleaning  ^j.^°^^  ^^' 


110  NOTES   ON   NURSING. 

inaccurate  information.  As  to  food,  for  instance,  I  often 
think  that  most  common  question,  How  is  your  appetite  *? 
can  only  be  put  because  the  questioner  believes  the  ques- 
tioned has  really  nothing  the  matter  with  him,  which  is 
very  often  the  case.  But  where  there  is,  the  remark 
holds  good  which  has  been  made  about  sleep.  The  same 
answer  will  often  be  made  as  regards  a  patient  who  can- 
not take  two  ounces  of  solid  food  per  diem,  and  a  patient 
"who  does  not  enjoy  five  meals  a  day  as  much  as  usual. 

Again,  the  question,  How  is  your  appetite?  is  often 
put  when  How  is  your  digestion  *?  is  the  question  meant. 
No  doubt  the  two  things  depend  on  one  another.  But 
they  are  quite  different.  Many  a  patient  can  eat,  if  you 
can  only  "  tempt  his  appetite."  The  fault  lies  in  your 
not  having  got  him  the  thing  that  he  fancies.  But  many 
another  patient  does  not  care  between  grapes  and  turnips 
— everything  is  equally  distasteful  to  him.  He  -would 
try  to  eat  anything  which  would  do  him  good ;  but  every- 
thing "makes  him  w^orse."  The  fault  here  generally 
lies  in  the  cooking.  It  is  not  his  "appetite"  which  re- 
quires "tempting,"  it  is  his  digestion  which  requires 
sparing.  And  good  sick  cookery  -vvill  save  the  digestion 
half  its  work. 

There  may  be  four  different  causes,  any  one  of  which 
will  produce  the  same  result,  viz.,  the  patient  slowly 
starving  to  death  from  want  of  nutrition  : 

1.  Defect  in  cooking  ; 

2.  Defect  in  choice  of  diet ; 

3.  Defect  in  choice  of  houjs  for  taking  diet ; 

4.  Defect  of  appetite  in  patient. 

Yet  all  these  are   generally  comprehended  in  the  one 
sweeping  assertion  that  the  patient  has  "  no  appetite." 
Surely  many  lives  might  be  saved  by  drawing  a  closer 


OBSERVATION    OF   THE   SICK.  Ill 

distinction  ;  for  the  remedies  are  as  diverse  as  the  causes. 
The  remedy  for  the  first  is  to  cook  better ;  for  the  second, 
to  choose  other  articles  of  diet ;  for  the  third,  to  watch 
for  the  hours  when  the  patient  is  in  want  of  food  ;  for  the 
fourth,  to  show  him  what  he  likes,  and  sometimes  unex- 
pectedly. But  no  one  of  these  remedies  will  do  for  any 
other  of  the  defects  not  corresponding  with  it. 

I  cannot  too  often  repeat  that  patients  are  generally 
either  too  languid  to  observe  these  things,  or  too  shy  to 
speak  about  them ;  nor  is  it  well  that  they  should  be 
made  to  observe  them,  it  fixes  their  attention  upon  them- 
selves. 

Again,  I  say,  what  is  the  nurse  or  friend  there  for 
except  to  take  note  of  these  things,  instead  of  the  patient 
doing  -so  ?* 

Again,  the  question  is  sometimes  put,  Is  there  diar-  Astodiaiv 
rhoea  *?  And  the  answer  will  be  the  same,  whether  it  is 
just  merging  into  cholera,  whether  it  is  a  trifling  degree 
brought  on  by  some  trifling  indiscretion,  which  will  cease 
the  moment  the  cause  is  removed,  or  whether  there  is  no 
diarrhoea  at  all,  but  simply  relaxed  bowels. 

It  is  useless  to  multiply  instances  of  this  kind.  As 
long  as  observation  is  so  little  cultivated  as  it  is  now,  I 
do  believe  that  it  is  better  for  the  physician  ?iot  to  see 
the  friends  of  the  patient  at  all.     They  will  oftener  mis- 


It  is  commonly  supposed  that  the  nurse  is  there  to  spare  the  More  impor- 

t  to  si)ar( 
patient 


patient  from  making  physical  exertion  for  himself — I  would  rather  ^^    *^  ^^^^^^ 


say  that  she  ought  to  be  there  to  spare  him  from  taking  thought  x^""^^l*  ^. 
for  himself.  And  I  am  quite  sure,  that  if  the  patient  were  spared  cal  exertion, 
all  thought  for  himself,  and  not  spared  all  physical  exertion,  he 
would  be  infinitely  the  gainer.  The  reverse  is  generally  the  case 
in  the  private  house.  In  the  hospital  it  is  the  relief  from  all 
anxiety,  afforded  by  the  rules  of  a  well-regulated  institution, 
which  has  often  such  a  beneficial  effect  upon  the  patient. 


112  NOTES    ON   NURSING. 

lead  him  than  not.     And  as  often  by  making  the  patient 
out  worse  as  better  than  he  really  is. 

In  the  case  of  infants,  everything  must  depend  upon 

the  accurate  observation  of  the  nurse  or  mother  who  has 

to  report.     And  how  seldom  is  this  condition  of  accuracy 

fulfilled. 

Means  of  ^  celebrated  man,  thouo^h  celebrated  only  for  foolish 

cultivating  pi-  •  i  •  •        i 

Bound  and     thinsfS.   has  told  us  that  one  of  his  mam  objects  m  the 

ready  obser-  °  .         ,  .  i      i     i  •       ^ 

vation.  education  of  his  son,  was  to  give  mm  a  ready  nabit  of 
accurate  observation,  a  certainty  of  perception,  and  that 
for  this  purpose  one  of  his  means  was  a  month's  course 
as  follows  : — he  took  the  boy  rapidly  past  a  toy-shop  ;  the 
father  and  son  then  described  to  each  other  as  many  of 
the  objects  as  they  could,  which  they  had  seen  in  passing 
the  windows,  noting  them  down  with  pencil  and  paper, 
and  returning  afterwards  to  verify  their  own  accuracy. 
The  boy  always  succeeded  best,  e.g.,  if  the  father  described 
30  objects,  the  boy  did  40,  and  scarcely  ever  made  a  mis- 
take. 

I  have  often  thought  how  wise  a  piece  of  education 
this  would  be  for  much  higher  objects  ;  and  in  our  call- 
ing  of  nurses  the  thing  itself  is  essential.  For  it  may 
safely  be  said,  not  that  the  habit  of  ready  and  correct  ob- 
servation will  by  itself  make  us  useful  nurses,  but  that 
without  it  we  shall  be  useless  with  all  our  devotion. 

I  have  known  a  nurse  in  charge  of  a  set  of  wards,  who 
not  only  carried  in  her  head  all  the  little  varieties  in  the 
diets  which  each  patient  was  allowed  to  fix  for  himself, 
but  also  exactly  what  each  patient  had  taken  during  each 
day.  I  have  known  another  nurse  in  charge  of  one  single 
patient,  who  took  away  his  meals  day  after  day  all  but 
untouched,  and  never  knew  it. 

If  you  find  it  helps  you  to  note  down  such  things  on 


OBSERVATION    OF   THE   SICK.  113 

a  bit  of  paper,  in  pencil,  by  all  means  do  so.  I  think  it 
more  often  lames  than  strengthens  the  memory  and 
observation.  But  if  you  cannot  get  the  habit  of  ob- 
servation one  way  or  other,  you  had  better  give  up  the 
being  a  nurse,  for  it  is  not  your  calling,  however  kind 
and  anxious  you  may  be. 

Surely  you  can  learn  at  least  to  judge  with  the  eye 
how  much  an  oz.  of  solid  food  is,  how  much  an  oz.  of 
liquid.  You  will  find  this  helps  your  observation  and 
memory  very  much,  you  will  then  say  to  yourself,  "A. 
took  about  an  oz.  of  his  meat  to  day ;"  "  B.  took  three 
times  in  24  hours  about  ^  pint  of  beef  tea ;"  instead  of 
saying  "B.  has  taken  nothing  all  day,"  or  "I  gave  A. 
his  dinner  as  usual." 

I  have  known  several  of  our  real  old-fashioned  hospital  Sound  and 

^  ready  obser- 

"  sisters,"  who  could,  as  accurately  as  a  measuring  glass,  J^^jjy^^ 
measure  out  all  their  patients'  wine  and  medicine  by  the  nurse, 
eye,  and  never  be  wrong.  I  do  not  recommend  this,  one 
must  be  very  sure  of  one's  self  to  do  it.  I  only  mention 
it,  because  if  a  nurse  can  by  practice  measure  medicine 
by  the  eye,  surely  she  is  no  nurse  who  cannot  measure  by 
the  eye  about  how  much  food  (in  oz.)  her  patient  has 
taken.*     In  hospitals  those  who  cut  up  the  diets  give 

*  It  may  be  too  broad  an  assertion,   and  it  certainly  sounds  English  wo- 
like  a  paradox.     But  I  think  that  in  no  country  are  women  to  be  g^eat  ca- 
found  so  deficient  in  ready  and  sound  observation  as  in  England,  ^^^'[j^^g' 
while  peculiarly  capable  of  being  trained  to  it.     The  French  or  practice  in 
Irish  woman  is  too  quick  of  perception  to  be  so  sound  an  ob-  yation. 
server — the  Teuton  is  too  slow  to  be  so  ready  an  observer  as  the 
English  woman  might  be.     Yet  English  women  lay  themselves 
open  to  the  charge  so  often  made  against  them  by  men,  viz.,  that 
they  are  not  to  be  trusted  in  handicrafts  to  which  their  strength 
is  quite  equal,  for  want  of  a  practised  and  steady  observation. 
In  countries  where  women  (with  average  intelligence  certainly 


114  NOTES    ON   NUESING. 

with  sufficient  accuracy,  to  each  patient,  his  12  oz.  or  his 
G  oz.  of  meat  without  weighing.  Yet  a  nurse  will  often 
have  patients  loathing  all  food  and  incapable  of  any  will 
to  get  well,  who  just  tumble  over  the  contents  of  the  plate 
or  dip  the  spoon  in  the  cup  to  deceive  the  nurse,  and  she 

not  superior  to  that  of  English  women)  are  employed,  e.  g.,  in 
dispensing,  men  responsible  for  what  these  women  do  (not 
theorizing  about  man's  and  woman's  "missions,")  have  stated 
that  they  preferred  the  service  of  women  to  that  of  men,  as  being 
more  exact,  more  careful,  and  incurring  fewer  mistakes  of  inad- 
vertence. 

Kow  certainly  EngUsh  women  are  peculiarly  capable  of  attain- 
ing to  this. 

I  remember  when  a  child,  hearing  the  story  of  an  accident, 
related  by  some  one  who  sent  two  girls  to  fetch  a  "  bottle  of  sal- 
volatile  from  her  room  ;"  "  Mary  could  not  stir,"  she  said,  *'  Fanny 
ran  and  fetched  a  bottle  that  was  not  salvolatile,  and  that  was  not 
in  my  room." 

Now  this  sort  of  thing  pursues  every  one  through  life.  A 
woman  is  asked  to  fetch  a  large  new  bound  red  book,  lying  on  the 
table  by  the  window,  and  she  fetches  five  small  old  boarded  brown 
books  lying  on  the  shelf  by  the  fire.  And  this,  though  she  has 
"put  that  room  to  rights"  every  day  for  a  month  perhaps,  and 
must  have  observed  the  books  every  day,  lying  in  the  same  places, 
for  a  month,  if  she  had  any  observation. 

Habitual  observation  is  the  more  necessary,  when  any  sudden 
call  arises.  If  "Fanny"  had  observed  "  the  bottle  of  salvolatile" 
in  "  the  aunt's  room,"  every  day  she  was  there,  she  would  more 
probably  have  found  it  when  it  was  suddenly  wanted. 

There  are  two  causes  for  these  mistakes  of  inadvertence.  1.  A 
want  of  ready  attention ;  only  a  part  of  the  request  is  heard  at 
all.     2.  A  want  of  the  habit  of  observation. 

To  a  nurse  I  would  add,  take  care  that  you  always  put  the 
same  things  in  the  same  places  ;  you  don't  know  how  suddenly 
you  may  be  called  on  some  day  to  find  something,  and  may  not 
be  able  to  remember  in  your  haste  where  you  yourself  had  put  it, 
if  your  memory  is  not  in  the  habit  of  seeing  the  thing  there  always. 


OBSEKYATION    OF   TUE   SICK.  115 

will  take  it  away  without  ever  seeing  tliat  tliere  is  just 
the  same  quantity  of  food  as  when  she  brought  it,  and 
she  will  tell  the  doctor,  too,  that  the  patient  has  eaten  all 
his  diets  as  usual,  w^hen  all  she  ought  to  have  meant  is 
that  she  has  taken  away  his  diets  as  usual. 

Now  what  kind  of  a  nurse  is  this '? 

I  would  call  attention  to   something  else,  in  which  Bifference 

°  '  ot  excitable 

nurses  frequently  fail  in  observation.     There  is  a  well- and  «ctM- 

■^  •'  _  ^      mulative- 

marked  distinction  between  the  excitable  and  what  I  will  tempera- 
call  the  accumulative  temperament  in  patients.  One  will 
blaze  up  at  once,  under  any  shock  or  anxiety,  and  sleep 
very  comfortably  after  it ;  another  will  seem  quite  calm 
and  even  torpid,  under  the  same  shock,  and  people  say, 
"  He  hardly  felt  it  at  all,"  yet  you  will  find  him  some  time 
after  slowly  sinking.  The  same  remark  applies  to  the 
action  of  narcotics,  of  aperients,  which,  in  the  one,  take 
effect  directly,  in  the  other  not  perhaps  for  twenty-four 
hours.  A  journey,  a  visit,  an  unwonted  exertion,  will 
affect  the  one  immediately,  but  he  recovers  after  it ;  the 
other  bears  it  very  well  at  the  time,  apparently,  and  dies 
or  is  prostrated  for  life  by  it.  People  often  say  how  dif- 
ficult the  excitable  temperament  is  to  manage.  I  say 
how  difficult  is  the  accumulative  temperament.  With  the 
first  you  have  an  out-break  which  you  could  anticipate, 
and  it  is  all  over.  With  the  second  you  never  know 
where  you  are — you  never  know  when  the  consequences 
are  over.  And  it  requires  your  closest  observation  to 
know  what  are  the  consequences  of  what — for  the  con- 
sequent by  no  means  foUow^s  immediately  upon  the  ante- 
cedent— and  coarse  observation  is  utterly  at  fault. 

Almost  all  superstitions  are  owing  to  bad  observa-  tij^J^Jv^Ju'ir 
tion,  to  the  post  hoc^  ergo  propter  hoc ;  and  bad  observers  tf^^*^^'^*''^^'^* 
are  almost  all  superstitious.     Farmers  used  to  attribute 


116  NOTES    ON   NUESING. 

disease  among  cattle  to  witchcraft ;  weddings  have  heen 
attributed  to  seeing  one  magpie,  deaths  to  seeing  three  ; 
and  I  have  heard  the  most  highly  educated  now-a-days 
draw  consequences  for  the  sick  closely  resembling  these, 
rhrsiorrno-  Another  remark  :  although  there  is  unquestionably  a 

ease  little      ithysiognomy  of  disease  as  well  as  of  health  ;  of  all  parts 

shewn  by 

tho  face.  of  the  body,  the  face  is  perhaps  the  one  which  tells  the 
least  to  the  common  observer  or  the  casual  visitor.  Be- 
cause, of  all  parts  of  the  body,  it  is  the  one  most  ex- 
posed to  other  influences,  besides  health.  And  people 
never,  or  scarcely  ever,  observe  enough  to  know  how  to 
distinguish  between  the  effect  of  exposure,  of  robust 
health,  of  a  tender  skin,  of  a  tendency  to  congestion,  of 
suffusion,  flushing,  or  many  other  things.  Again,  the 
face  is  often  the  last  to  shew  emaciation.  I  should  say 
that  the  hand  was  a  much  surer  test  than  the  face,  both 
as  to  flesh,  colour,  circulation,  &c.,  &c.  It  is  true  that 
there  are  some  diseases  which  are  only  betrayed  at  all  by 
something  in  the  face,  e.^.,  the  eye  or  the  tongue,  as  great 
irritability  of  brain  by  the  appearance  of  the  pupil  of 
the  eye.  But  we  are  talking  of  casual,  not  minute,  ob- 
servation. And  few  minute  observers  will  hesitate  to 
say  that  far  more  untruth  than  truth  is  conveyed  by  the 
oft  repeated  words.  He  looh  well,  or  ill,  or  better  or 
worse. 

Wonderful  is  the  way  in  which  people  will  go  upon 
the  slightest  observation,  or  often  upon  no  observation  at 
all,  or  upon  some  smo  which  the  world's  experience,  if  it 
had  any,  would  have  pronounced  utterly  false  long  ago. 

I  have  known  patients  dying  of  sheer  pain,  exhaus- 
tion, and  want  of  sleep,  from  one  of  the  most  lingering 
and  painful  diseases  known,  preserve,  till  within  a  few 
days  of  death,  not  only  the  healthy  colour  of  the  cheeky 


OBSERVATION    OF   THE   SICK.  117 

but  the  mottled  aj)pearance  of  a  robust  child.  And 
scores  of  times  have  I  heard  these  unfortunate  creatures 
assailed  with,  "  I  am  glad  to  see  you  looking  so  well." 
"  I  see  no  reason  why  you  should  not  live  till  ninety 
years  of  age."  "  Why  don't  you  take  a  little  more  ex- 
ercise and  amusement,"  with  all  the  other  commonplaces 
with  which  we  are  so  familiar. 

There  is,  unquestionably,  a  physiognomy  of  disease. 
Let  the  nurse  learn  it. 

The  experienced  nurse  can  always  tell  that  a  person 
has  taken  a  narcotic  the  night  before  by  the  patchiness 
of  the  colour  about  the  face,  when  the  re-action  of  de- 
pression has  set  in ;  that  very  colour  which  the  inexpe- 
rienced will  point  to  as  a  proof  of  health. 

There  is,  again,  a  faintness,  which  does  not  betray 
itself  by  the  colour  at  all,  or  in  which  the  patient  be- 
comes brown  instead  of  white.  There  is  a  faintness  of 
another  kind  which,  it  is  true,  can  always  be  seen  by  the 
paleness. 

But  the  nurse  seldom  distinguishes.  She  will  talk 
to  the  patient  who  is  too  faint  to  move,  without  the  least 
scruple,  unless  he  is  pale  and  unless,  luckily  for  him, 
the  muscles  of  the  throat  are  aftected  and  he  loses  his 
voice. 

Yet  these  two  faintnesses  are  perfectly  distinguisha- 
ble, by  the  mere  countenance  of  the  patient. 

Again,  the  nurse  must  distinguish  between  the  idio- 
syncracies  of  patients.  One  likes  to  suffer  out  all  his 
suffering  alone,  to  be  as  little  looked  after  as  possible. 
Another  likes  to  be  perpetually  made  much  of  and  pitied, 
and  to  have  some  one  always  by  him.  Both  these  pecu- 
liarities might  be  observed  and  indulged  much  more  than 
they  are.     For  quite  as  often  does  it  happen  that  a  busy 


Peculinritic 
of  xjationts. 


118  NOTES    ON    NURSING. 

attendance  is  forced  upon  the  first  patient,  who  wishes 
for  nothing  but  to  be  "  let  alone,"  as  that  the  second  is 
left  to  think  himself  neglected. 
Nurse  must         A2:ain,  I  think  that  few  thino^s  press  so  heavily  on 

observe  for  p  ,  -,    .  -,  /    .n  n 

herself  in-     one  Suffering  from  long  and  incurable  illness,  as  the  ne- 

crease  of  «  i  .  i      /•  •  •  i»  i 

patient's       cessitv  of  recording  m  words  irom  time  to  time,  lor  the 

W0tlkD6^S 

patient  will  information  of  the  nurse,  who  will  not   otherwise  see, 

not  tell  her.  ,         ,  .  ,  i  .  i     i  i  i     i 

that  he  cannot  do  this  or  that,  which  he  could  do  a 
month  or  a  year  ago.  What  is  a  nurse  there  for  if  she 
cannot  observe  these  things  for  herself?  Yet  I  have 
known — and  known  too  among  those — and  chieflij  among 
those — whom  money  and  position  put  in  possession  of 
everything  which  money  and  position  could  give — I  have 
known,  I  say,  more  accidents  (fatal,  slowly  or  rapidly) 
arising  from  this  want  of  observation  among  nurses  than 
from  almost  anything  else.  Because  a  patient  could  get 
out  of  a  warm-bath  alone  a  month  ago — because  a  pa- 
tient could  walk  as  far  as  his  bell  a  week  ago,  the  nurse 
concludes  that  he  can  do  so  now.  She  has  never  ob- 
served the  change ;  and  the  patient  is  lost  from  being 
left  in  a  helpless  state  of  exhaustion,  till  some  one  acci- 
dentally comes  in.  And  this  not  from  any  unexpected 
apoplectic,  paralytic,  or  fainting  fit  (though  even  these 
could  be  expected  far  more,  at  least,  than  they  are  now, 
if  we  did  but  ohserve).  No,  from  the  unexpected,  or  to 
be  expected,  inevitable,  visible,  calculable,  uninterrupted 
increase  of  weakness,  which  none  need  fail  to  observe. 
Accidents  Again,  a  patient  not  usually  confined  to  bed,  is  com-. 

arisinir  from  o        7       r 

the  nurse's    pelled  by  an  attack  of  diarrhoea,  vomiting,  or  other  ac-» 

servation.      cidcut,  to  keep  Ms  bed  for  a  few  days  ;   he  gets  up  for 

the  first  time,  and  the  nurse  lets  him.  go  into  another 

room,  without,  coming  in,  a  few  minutes  afterwards,  to 

look  after  him.     It  never  occurs  to  her  that  he  is  quite 


OBSERVATION    OF    THE    SICK.  119 

certain  to  be  faint,  or  cold,  or  to  want  something.  She 
says,  as  her  excuse,  Oh,  he  does  not  like  to  be  fidgetted 
after.  Yes,  he  said  so  some  weeks  ago ;  but  he  never 
said  he  did  not  like  to  be  "  fidgetted  after,"  when  he  is 
in  the  state  he  is  in  now ;  and  if  he  did,  you  ought  to 
make  some  excuse  to  go  in  to  him.  More  patients  have 
been  lost  in  this  way  than  is  at  all  generally  known,  viz., 
from  relapses  brought  on  by  being  left  for  an  hour  or  two 
faint,  or  cold,  or  hungry,  after  getting  up  for  the  first 
time. 

Yet  it  appears  that  scarcely  any  improvement  in  the  j^^^^L  ^f 
faculty  of  observing  is  being  made.  Vast  has  been  the  jJ|^Je*"gie" 
increase  of  knowledge  in  pathology — that  science  which 
teaches  us  the  final  change  produced  by  disease  on  the 
human  frame — scarce  any  in  the  art  of  observing  the 
signs  of  the  change  while  in  progress.  Or,  rather,  is 
it  not  to  be  feared  that  observation,  as  an  essential  part 
of  medicine,  has  been  declining  ? 

Which  of  us  has  not  heard  fifty  times,  from  one  or 
another,  a  nurse,  or  a  friend  of  the  sick,  aye,  and  a  med- 
ical friend  too,  the  following  remark  : — ^'  So  A  is  worse, 
or  B  is  dead.  I  saw  him  the  day  before  ;  I  thought  him 
so  much  better ;  there  certainly  was  no  appearance  from 
which  one  could  have  expected  so  sudden  (?)  a  change." 
I  have  never  heard  any  one  say,  though  one  would  think 
it  the  more  natural  thing,  "There  must  have  been  so7ne 
appearance,  which  I  should  have  seen  if  I  had  but  looked ; 
let  me  try  and  remember  what  there  was,  that  I  may 
observe  another  time."  No,  this  is  not  what  people  say. 
They  boldly  assert  that  there  was  nothing  to  observe, 
not  that  their  observation  was  at  fault. 

Let  people  who  have  to  observe  sickness  and  death 
look  back   and  try  to  register  in  their  observation  the 


120  NOTES    ON    NUKSING. 

appearances  which  have  preceded  relapse,  attack,  or 
death,  and  not  assert  that  there  were  none,  or  that  there 
were  not  the  right  ones.* 
ot>nI?ai''''  ^  ^^^^^  of  the  habit  of  observing  conditions  and  an 
couditions.  inveterate  habit  of  taking  averages  are  each  of  them 
often  equally  misleading. 

Men  whose  profession  like  that  of  medical  men  leads 
them  to  observe  only,  or  chiefly,  palpable  and  permanent 
organic  changes  are  often  just  as  wrong  in  their  opinion 
of  the  result  as  those  who  do  not  observe  at  all.  For 
instance,  there  is  a  broken  leg ;  the  surgeon  has  only  to 
look  at  it  once  to  knov\^ ;  it  will  not  be  difl:erent  if  he  sees 
it  in  the  morning  to  what  it  would  have  been  had  he 
seen  it  in  the  evening.  And  in  whatever  conditions  the 
patient  is,  or  is  likely  to  be,  there  will  still  be  the  broken 
leg,  until  it  is  set.  The  same  with  many  organic  dis- 
eases. An  experienced  physician  has  but  to  feel  the 
pulse  once,  and  he  knows  that  there  is  aneurism  which 
will  kill  some  time  or  other. 

But  with  the  great  majority  of  cases,  there  is  nothing 
of  the  kind ;  and  the  power  of  forming  any  correct  opin- 
ion as  to  the  result  must  entirely  depend  uj)on  an  enquiry 

Approach  of        *  It  falls  to  few  ever  to  hare  had  the  opportunity  of  observing 

ness  In^'iio"    ^^^  different  aspects  which  the  human  face  puts  on  at  the  sudden 

means  an       approach  of  certain  forms  of  death  by  violence  ;  and  as  it  is  a 

invariable         ^  ^  .     , 

cflfect,  as  we  knowledge  of  httle  use,  I  only  mention  it  here  as  being  the  most 

nove'ls.  Startling  example  of  what  I  mean.     In  the  nervous  temperament 

the  face  becomes  pale  (this  is  the  only  recogriised  effect) ;  in  the 
sanguine  temperament  purple  ;  in  the  bihous  yellow,  or  every  man- 
ner of  colour  in  patches.  Now,  it  is  generally  supposed  that  pale- 
ness is  the  one  indication  of  almost  any  violent  change  in  the 
human  being,  whether  from  terror,  disease,  or  anything  else.  There 
can  be  no  more  false  observation.  Granted,  it  is  the  one  recog- 
nised livery,  as  I  have  said — de  rigueur  in  novels,  but  nowhere  else. 


OBSERYATIOX    OF   THE   SICK.  121 

into  all  the  conditions  in  whicli  the  patient  lives.  In  a 
complicated  state  of  society  in  large  towns,  death,  as 
every  one  of  great  experience  knows,  is  far  less  often 
produced  by  any  one  organic  disease  than  by  some  ill- 
ness, after  many  other  diseases,  producing  just  the  sum 
of  exhaustion  necessary  for  death.  There  is  nothing  so 
absurd,  nothing  so  misleading  as  the  verdict  one  so 
often  hears:  So-and-so  has  no  organic  disease, — there  is 
no  reason  why  he  should  not  live  to  extreme  old  age ; 
sometimes  the  clause  is  added,  sometimes  not :  Provided 
he  has  quiet,  good  food,  good  air,  &c.,  &c.,  &c. :  the  ver- 
dict is  repeated  by  ignorant  people  luithout  the  latter 
clause ;  or  there  is  no  possibility  of  the  conditions  of  the 
latter  clause  being  obtained ;  and  this,  the  onhj  essential 
part  of  the  whole,  is  made  of  no  effect.  I  have  heard  a 
physician,  deservedly  eminent,  assure  the  friends  of  a 
patient  of  his  recovery.  Why  ?  Because  he  had  now 
prescribed  a  course,  every  detail  of  w^hich  the  patient 
had  followed  for  years.  And  because  he  had  forbidden 
a  course  which  the  patient  could  not  by  any  possibility 
alter.* 

*  I  have  kuown  two  cases,  the  one  of  a  man  who  intentionally 
and  repeatedly  displaced  a  dislocation,  and  was  kept  and  petted 
by  all  the  surgeons ;  the  other  of  one  who  was  pronounced  to 
have  nothing  the  matter  wdth  him,  there  being  no  organic  change 
perceptible,  but  who  died  within  the  week.  In  both  these  cases, 
it  was  the  nurse  who,  by  accurately  pointing  out  what  she  had 
accurately  observed,  to  the  doctors,  saved  the  one  case  from  per- 
severing in  a  fraud,  the  other  from  being  discharged  when  actu- 
ally in  a  dying  state. 

I  will  even  go  further  and  say,  that  in  diseases  which  have 
their  origin  in  the  feeble  or  irregular  action  of  some  function,  and 
not  in  organic  change,  it  is  quite  an  accident  if  the  doctor  who 
sees  the  case  only  once  a  day,  and  generally  at  the  same  time, 
can  form  any  but  a  negative  idea  of  its  real  condition.  In  the 
6 


122  NOTES    ON   NURSING. 

Undoubtedly  a  person  of  no  scientific  knowledge 
whatever  but  of  observation  and  experience  in  these 
kinds  of  conditions,  will  be  able  to  arrive  at  a  much 

middle  of  the  day,  when  such  a  patient  has  been  refreshed  by 
light  and  air,  by  his  tea,  his  beef-tea,  and  his  brandy,  by  hot 
bottles  to  his  feet,  by  being  washed  and  by  clean  linen,  you  can 
scarcely  believe  that  he  is  the  same  person  as  lay  with  a  rapid  flut- 
tering pulse,  with  puffed  eye-lids,  with  short  breath,  cold  limbs,  and 
unsteady  hands,  this  morning.  Now  what  is  a  nurse  to  do  in  such 
a  case  ?  Not  cry,  "  Lord,  bless  you,  sir,  why  you'd  have  thought 
he  were  a  dying  all  night."  "this  may  be  true,  but  it  is  not  the 
way  to  impress  with  the  truth  a  doctor,  more  capable  of  forming 
a  judgment  from  the  facts,  if  he  did  but  know  them,  than  you 
are.  "What  he  wants  is  not  your  opinion,  however  respectfully 
given,  but  your  facts.  In  all  diseases  it  is  important,  but  in 
diseases  which  do  not  run  a  distinct  and  fixed  course,  it  is  not 
only  important,  it  is  essential  that  the  facts  the  nurse  alone  can 
observe,  should  be  accurately  observed,  and  accurately  reported 
to  the  doctor. 

I  must  direct  the  nurse's  attention  to  the  extreme  variation 
there  is  not  unfrequently  in  the  pulse  of  such  patients  during  the 
day.  A  very  common  case  is  this :  Between  3  and  4  a.  m.,  the 
pulse  become  quick,  perhaps  130,  and  so  thready  it  is  not  like  a 
pulse  at  all,  but  like  a  string  vibrating  just  underneath  the  skin. 
After  this  the  patient  gets  no  more  sleep.  About  mid-day  the 
pulse  has  come  down  to  80 ;  and  though  feeble  and  compressible, 
is  a  very  respectable  pulse.  At  night,  if  the  patient  has  had  a 
day  of  excitement,  it  is  almost  imperceptible.  But,  if  the  patient 
has  had  a  good  day,  it  is  stronger  and  steadier,  and  not  quicker 
than  at  mid-day.  This  is  a  ^common  history  of  a  common  pulse ; 
and  others,  equally  varying  during  the  day,  might  be  given. 
Now,  in  inflammation,  which  may  almost  always  be  detected  by 
the  pulse,  in  typhoid  fever,  which  is  accompanied  by  the  low 
pulse  that  nothing  will  raise,  there  is  no  such  great  variation. 
And  doctors  and  nurses  become  accustomed  not  to  look  for  it. 
The  doctor  indeed  cannot.  But  the  variation  is  in  itself  an  im- 
portant feature. 

Cases  like  the  above  often  "go  off  rather  suddenly,"  as  it  is 


OBSERVATION    OF   THE   SICK.  123 

truer  guess  as  to  the  probable  duration  of  life  of  mem- 
bers of  a  family  or  inmates  of  a  house,  than  the  most 
scientific  physician  to  whom  the  same  persons  are  brought 
to  have  their  pulse  felt ;  no  enquiry  being  made  into 
their  conditions. 

In  Life  Insurance  and  such  like  societies,  were  they 
instead  of  having  the  person  examined  by  the  medical 
man,  to  have  the  houses,  conditions,  ways  of  life,  of  these 
persons  examined,  at  how  much  truer  results  would  they 
arrive !  W.  Smith  appears  a  fine  hale  man,  but  it  might 
be  known  that  the  next  cholera  epidemic  he  runs  a  bad 
chance.  Mr.  and  Mrs.  J.  are  a  strong  healthy  couple, 
but  it  might  be  known  that  they  live  in  such  a  house,  in 
such  a  part  of  London,  so  near  the  river  that  they  will 
kill  four-fifths  of  their  children  ;  which  of  the  children 
will  be  the  ones  to  survive  might  also  be  known. 

called,  from  some  trifliug  ailment  of  a  few  days,  which  just  makes 
up  the  sum  of  exhaustion  necessary  to  produce  death.  And 
everybody  cries,  Who  would  have  thought  it  ?  except  the  observ- 
ing nurse,  if  there  is  one,  who  had  always  expected  the  exhaus- 
tion to  come,  from  which  there  would  be  no  rally,  because  she 
knew  the  patient  had  no  capital  in  strength  on  which  to  draw,  if 
he  failed  for  a  few  days  to  make  his  barely  daily  income  in  sleep 
and  nutrition. 

I  have  often  seen  really  good  nurses  distressed,  because  they 
could  not  impress  the  doctor  with  the  real  danger  of  their  pa- 
tient; and  quite  provoked  because  the  patient  "would  look" 
either  "so  much  better"  or  "  so  much  worse  "  than  he  really  is 
"  when  the  doctor  was  there."  The  distress  is  very  legitimate, 
but  it  generally  arises  from  the  nurse  not  having  the  power  of 
laying  clearly  and  shortly  before  the  doctor  the  facts  from  which 
she  derives  her  opinion,  or  from  the  doctor  being  hasty  and  inex- 
perienced, and  not  capable  of  eliciting  them.  A  man  who  really 
cares  for  his  patients,  will  soon  learn  to  ask  for  and  appreciate  the 
information  of  a  nurse,  who  is  at  once  a  careful  observer  and  a 
clear  reporter. 


124  NOTES    ON   NTjESING. 

"Average  Averaofes  ao:ain  seduce  us  away  from  minute  observa- 

rate  of  mor-  &  o  J 

tuiity"  tells  tion.     "  Averas^e  mortalities  "  merely  tell  that  so  many 

us  only  that  ...  . 

so  many  per  per  Cent,  die  in  this  town  and  so  many  in  that,  per  an- 
die.   Obser-  num.     But  whether  A  or  B  will  be  amon"'  these,  the 

vation  must 

ieWu&which  " averaf:^e  rate  "  of  course  does  not  tell.     We  know,  say, 

in  the  hun-       ,  „  ^         , 

dred  they      that  from  22  to  24  per  1,000  will  die  in  London  next 

v\ill  be  who 

will  die.        year.     But  minute  enquiries  into  conditions  enable  us  to 


know  that  in  such  a  district,  nay,  in  such  a  street,- 
even  on  one  side  of  that  street,  in  such  a  particular  house, 
or  even  on  one  floor  of  that  particular  house,  will  be  the 
excess  of  mortality,  that  is,  the  person  will  die  who 
ought  not  to  have  died  before  old  age. 

Now,  would  it  not  very  materially  alter  the  opinion 
of  whoever  were  endeavouring  to  form  one,  if  he  knew 
that  from  that  floor,  of  that  house,  of  that  street  the  man 
came. 

Much  more  precise  might  be  our  observations  even 
than  this,  and  much  more  correct  our  conclusions. 

It  is  well  known  that  the  same  names  may  be  seen 
constantly  recurring  on  w^orkhouse  books  for  generations. 
That  is,  the  persons  were  born  and  brought  up,  and  will 
be  born  and  brought  up,  generation  after  generation,  in 
the  conditions  which  make  paupers.  Death  and  disease 
are  like  the  workhouse,  they  take  from  the  same  family, 
the  same  house,  or  in  other  words,  the  same  conditions. 
Why  will  we  not  observe  what  they  are  ? 

The  close  observer  may  safely  predict  that  such  a 
family,  whether  its  members  marry  or  not,  wall  become 
extinct ;  that  such  another  will  degenerate  morally  and 
physically.  But  who  learns  the  lesson  ?  On  the  con- 
trary, it  maybe  well  known  that  the  children  die  in  such 
a  house  at  the  rate  of  8  out  of  10  ;  one  would  think  that 
nothing  more  need  be  said  ;  for  how  could  Providence 


OBSEllVATION    OF   THE   SICK.  125 

speak  more  distinctly '?  yet  nobody  listens,  the  family 
goes  on  living  there  till  it  dies  out,  and  then  some  other 
family  takes  it.  Neither  would  they  listen  "  if  one  rose 
from  the  dead." 

In  dwellins:  upon  the  vital  importance  of  sound  ob-  Whatobser- 

°      •"■  ■'•  vution  15  for. 

servation,  it  must  never  be  lost  sight  of  what  observation 
is  for.  It  is  not  for  the  sake  of  piling  up  miscellaneous 
information  or  ciuious  facts,  but  for  the  sake  of  saving 
life  and  increasing  health  and  comfort.  The  caution 
may  seem  useless,  but  it  is  quite  surprising  how  many 
men  (some  women  do  it  too),  practically  behave  as  if  the 
scientific  end  were  the  only  one  in  view,  or  as  if  the  sick 
body  were  but  a  reservoir  for  stowing  medicines  into, 
and  the  surgical  disease  only  a  curious  case  the  sufferer 
has  made  for  the  attendant's  special  information.  This 
is  really  no  exaggeration.  You  think,  if  you  suspected 
your  patient  was  being  poisoned,  say,  by  a  copper  kettle, 
you  would  instantly,  as  you  ought,  cut  off  all  possible 
connection  between  him  and  the  suspected  source  of  in- 
jury, without  regard  to  the  fact  that  a  curious  mine  of 
observation  is  thereby  lost.  But  it  is  not  everybody  who 
does  so,  and  it  has  actually  been  made  a  question  of  med- 
ical ethics,  what  should  the  medical  man  do  if  he  sus- 
pected poisoning?  The  answer  seems  a  very  simple 
one, — insist  on  a  confidential  nurse  being  placed  with 
the  patient,  or  give  up  the  case. 

And  remember  every  nurse  should  be  one  who  is  to  "^^^at  a  con- 

•^  .  fidential 

be  depended  upon,  in  other  words,  capable  of  being  a  nurse  should 
"  confidential  "  nurse.  She  does  not  know  how  soon  she 
may  find  herself  placed  in  such  a  situation ;  she  must  be 
no  gossip,  no  vain  talker  ;  she  should  never  answer  ques- 
tions about  her  sick  except  to  those  who  have  a  right  to 
ask  them ;  she  must,  I  need  not  say,  be  strictly  sober 


12G  NOTES   ON   NUESING. 

and  honest ;  but  more  than  this,  she  must  be  a  religious 
and  devoted  woman  ;  she  must  have  a  respect  for  her 
own  calling,  because  God's  precious  gift  of  life  is  often 
literally  placed  in  her  hands ;  she  must  be  a  sound,  and 
close,  and  quick  observer  ;  and  she  must  be  a  woman  of 
delicate  and  decent  feeling. 
Observation         To  retum  to  the  question  of  what  observation  is  for : 

is  for  practi-  .  ,         ,   . 

cai  pur-        — It  would  really  seem  as  if  some  had  considered  it  as 

poses.  «  T  .  ,     .    ,       . 

its  own  end,  as  if  detection,  not  cure,  was  their  business ; 
nay  more,  in  a  recent  celebrated  trial,  three  medical  men, 
according  to  their  own  account,  suspected  poison,  pre- 
scribed for  dysentery,  and  left  the  patient  to  the  poisoner. 
This  is  an  extreme  case.  But  in  a  small  way,  the  same 
manner  of  acting  falls  under  the  cognizance  of  us  all. 
How  often  the  attendants  of  a  case  have  stated  that  they 
knew  perfectly  well  that  the  patient  could  not  get  well 
in  such  an  air,  in  such  a  room,  or  under  such  circum- 
siances,  yet  have  gone  on  dosing  him  with  medicine,  and 
making  no  effort  to  remove  the  poison  from  him,  or  him 
from  the  poison  which  they  knew  was  killing  him ;  nay, 
more,  have  sometimes  not  so  much  as  mentioned  their 
conviction  in  the  right  quarter — that  is,  to  the  only  per- 
son who  could  act  in  the  matter. 


CONCLUSION. 


Sanitary  The  wholc  of  the  preceding  remarks  apply  even  more 

essentmun  to  children  and  to  puerperal  woman  than  to  patients  in 
Scai"^^^^  general.  They  also  apply  to  the  nursing  of  surgical, 
nSfto^u-  quite  as  much  as  to  that  of  medical  cases.  Indeed,  if  it 
Jfcaf  nur?'  be  possible,  cases  of  external  injury  require  such  care  even 
^^'  more  than  sick.     In  surgical  wards,  one  duty  of  every 


CONCLUSION.  127 

nurse  certainly  {^prevention.  Fever,  or  hospital  gangrene, 
or  pyoemia,  or  purulent  discharge  of  some  kind  may  else 
supervene.  Has  she  a  case  of  compound  fracture,  of  am- 
putation, or  of  erysipelas,  it  may  depend  very  much  on 
how  she  looks  upon  the  things  enumerated  in  these  notes, 
whether  one  or  other  of  these  hospital  diseases  attacks 
her  patient  or  not.  If  she  allows  her  ward  to  become 
filled  with  the  peculiar  close  foetid  smell,  so  apt  to  be  pro- 
duced among  surgical  cases,  especially  where  there  is 
great  suppuration  and  discharge,  she  may  see  a  vigorous 
patient  in  the  prime  of  life  gradually  sink  and  die  where, 
according  to  all  human  probability,  he  ought  to  have  re- 
covered. The  surgical  nurse  must  be  ever  on  the  watch, 
ever  on  her  guard,  against  want  of  cleanliness,  foul  air, 
want  of  light,  and  of  warmth. 

Nevertheless  let  no  one  think  that  because  sanitary 
nursing  is  the  subject  of  these  notes,  therefore,  what  may 
be  called  the  handicraft  of  nursing  is  to  be  undervalued. 
A  patient  may  be  left  to  bleed  to  death  in  a  sanitary 
palace.  Another  who  cannot  move  himself  may  die  of 
bed-sores,  because  the  nurse  does  not  know  how  to  change 
and  clean  him,  while  he  has  every  requisite  of  air,  light, 
and  quiet.  But  nursing,  as  a  handicraft,  has  not  been 
treated  of  here  for  three  reasons  :  1.  That  these  notes  do 
not  pretend  to  be  a  manual  for  nursing,  any  more  than 
for  cooking  for  the  sick  ;  2.  That  the  writer,  who  has  her- 
self seen  more  of  what  may  be  called  surgical  nursing,  i.e. 
practical  manual  nursing,  than,  perhaps,  any  one  in 
Europe,  honestly  believes  that  it  is  impossible  to  learn  it 
from  any  book,  and  that  it  can  only  be  thoroughly  learnt 
in  the  wards  of  a  hospital ;  and  she  also  honestly  believes 
that  the  perfection  of  surgical  nursing  may  be  seen  prac- 
tised by  the  old-fashioned  "  Sister  "  of  a  London  hospital, 


128  NOTES    ON   NUKSING. 

as  it  can  be  seen  nowhere  else  in   Europe.     3.  While 
thousands  die  of  foul  air,  &c.,  who  have  this  surgical  nurs- 
ing to  perfection,  the  converse  is  comparatively  rare. 
Children :  To  revert  to  children.     They  are  much  more  suscep- 

their  greater 

suscepti-       tible  than  grown  people  to  all  noxious  influences.     They 

bility  to  the  i  i  •  .   i  i 

same  things,  are  affected  by  the  same  things,  but  much  more  quickly 
and  seriously,  viz.,  by  want  of  fresh  air,  of  proper  warmth, 
want  of  cleanliness  in  house,  clothes,  bedding,  or  body, 
by  startling  noises,  improper  food,  or  want  of  punctuality, 
by  dulness  and  by  want  of  light,  by  too  much  or  too  little 
covering  in  bed,  or  when  up,  by  want  of  the  spirit  of 
management  generally  in  those  in  charge  of  them.  One 
can,  therefore,  only  press  the  importance,  as  being  yet 
greater  in  the  case  of  children,  greatest  in  the  case  of 
sick  children,  of  attending  to  these  things. 

That  which,  however,  above  all,  is  known  to  injure 
children  seriously  is  foul  air,  and  most  seriously  at  night. 
Keeping  the  rooms  where  they  sleep  tight  shut  up,  is 
destruction  to  them.  And,  if  the  child's  breathing  be 
disordered  by  disease,  a  few  hours  only  of  such  foul  air 
may  endanger  its  life,  even  where  no  inconvenience  is  felt 
by  grown-up  persons  in  the  same  room. 

The  following  passages,  taken  out  of  an  excellent 
"  Lecture  on  Sudden  Death  in  Infancy  and  Childhood," 
just  published,  show  the  vital  importance  of  careful  nurs- 
ing of  children.  "In  the  great  majority  of  instances, 
when  death  suddenly  befalls  the  infant  or  young  child,  it 
is  an  accident;  it  is  not  a  necessary  result  of  any  disease 
from  which  it  is  suffering." 

It  may  be  here  added,  that  it  would  be  very  desir- 
able to  know  how  often  death  is,  with  adults,  "not  a 
necessary,  inevitable  result  of  any  disease."  Omit  the 
w^ord  "  sudden ;"  (for  sudden  death  is  comparatively  rare 


CONCLUSION.  129 

in  middle  age  ;)  and  the  sentence  is  almost  equally  true 
for  all  ages. 

The  following  causes  of  "accidental"  death  in  sick 
children  are  enumerated  : — "  Sudden  noises,  which  startle 
, — a  rapid  change  of  temperature,  which  chills  the  surface, 
though  only  for  a  moment — a  rude  awakening  from  sleep 
— or  even  an  over-hasty,  or  an  overfull  meal" — "any 
sudden  impression  on  the  nervous  system — any  hasty 
alteration  of  posture — in  short,  any  cause  whatever  by 
which  the  respiratory  process  may  be  disturbed." 

It  may  again  be  added,  that,  with  very  weak  adult 
patients,  these  causes  are  also  (not  often  "  suddenly  fatal," 
it  is  true,  but)  very  much  oftener  than  is  at  all  generally 
known,  irreparable  in  their  consequences. 

Both  for  children  and  for  adults,  both  for  sick  and 
for  well  (although  more  certainly  in  the  case  of  sick  chil- 
dren than  in  any  others),  I  would  here  again  repeat,  the 
most  frequent  and  most  fatal  cause  of  all  is  sleeping,  for 
even  a  few  hours,  much  more  for  weeks  and  months,  in 
foul  air,  a  condition  which,  more  than  any  other  condi- 
tion, disturbs  the  respiratory  process,  and  tends  to  pro- 
duce "  accidental "  death  in  disease. 

I  need  hardly  here  repeat  the  warning  against  any 
confusion  of  ideas  between  cold  and  fresh  air.  You  may 
chill  a  patient  fatally  without  giving  him  fresh  air  at  all. 
And  you  can  quite  well,  nay,  much  better,  give  him  fresh 
air  without  chilling  him.  This  is  the  test  of  a  good 
nurse. 

In  cases  of  long  recurring  faintnesses  from  disease, 
for  instance,  especially  disease  which  affects  the  organs 
of  breathing,  fresh  air  to  the  lungs,  warmth  to  the  sur- 
face, and  often  (as  soon  as  the  patient  can  swallow)  hot 
drink,  these  are  the  right  remedies  and  the  only  ones. 
6* 


130 


NOTES    ON   NURSING. 


Yet,  oftener  than  not,  you  see  the  nurse  or  mother  just 
reversing  this  ;  shutting  up  every  cranny  through  which 
fresh  air  can  enter,  and  leaving  the  body  cold,  or  perhaps 
throwing  a  greater  weight  of  clothes  upon  it,  when  al- 
ready it  is  generating  too  little  heat. 

"Breathing  carefully,  anxiously,  as  though  respira- 
tion were  a  function  which  required  all  the  attention  for 
its  performance,"  is  cited  as  a  not  unusual  state  in  chil- 
dren, and  as  one  calling  for  care  in  all  the  things  enumer- 
ated above.  That  breathing  becomes  an  almost  voluntary 
act,  even  in  grown  up  patients  who  are  very  weak,  must 
often  have  been  remarked. 

"  Disease  having  interfered  with  the  perfect  accom- 
plishment of  the  respiratory  function,  some  sudden  de- 
mand for  its  complete  exercise,  issues  in  the  sudden  stand- 
still of  the  whole  machinery,"  is  given  as  one  process  : 
— "  life  goes  out  for  want  of  nervous  power  to  keep  the 
vital  functions  in  activity,"  is  given  as  another,  by  which 
"  accidental "  death  is  most  often  brought  to  pass  in  in- 
fancy. 

Also  in  middle  age,  both  these  processes  may  be  seen 
ending  in  death,  although  generally  not  suddenly.  And 
I  have  seen,  even  in  middle  age,  the  "  sicdden  stand-still " 
here  mentioned,  and  from  the  same  causes. 

To  sum  up : — the  answer  to  two  of  the  commonest 

objections  urged,  one  by  women  themselves,  the  other  by 

men,  against  the  desirableness  of  sanitary  knowledge  for 

women,  ^;/hs  a  caution,  comprises  the  whole  argument  for 

Eeckiess       the  art  of  nursing. 

phySng  (1.)  It  is  often   said  by  men,  that  it  is  unwise  to 

ifeJkSowi-  teach  women  anything  about  these  laws  of  health,  be- 
fals  of  *^^  cause  they  will  take  to  physicking, — ^that  there  is  a  great 
caSeck"'^  deal  too  much  of  amateur  physicking  as  it  is,  which  is 

this. 


Biimmary. 


CONCLUSION.  131 

indeed  true.  One  eminent  physician  told  me  tliat  he 
had  known  more  calomel  given,  both  at  a  pinch  and  for 
a  continuance,  by  mothers,  governesses,  and  nurses,  to 
children  than  he  had  ever  heard  of  a  physician  prescrib- 
ing in  all  his  experience.  Another  says,  that  women's 
only  idea  in  medicine  is  calomel  and  aperients.  This  is 
undeniably  too  often  the  case.  There  is  nothing  ever 
seen  in  any  professional  practice  like  the  reckless  phys- 
icking by  amateur  females.*     But  this  is  just  what  the 

*  I  have  known  many  ladies  who,  having  once  obtained  a  Banger  of 
"blue  pill"  prescription  from  a  physician,  gave  and  took  it  as  a  by^amate^ 
common  aperient  two  or  three  times  a  week — with  what  effect  f^n^i^lcs. 
may  be  supposed.     In  one  case  I  happened  to  be  the  person  to 
inform  the  physician  of  it,  who  substituted  for  the  prescription  a 
comparatively  harmless  aperient  pill.     The  lady  came  to  me  and 
complained  that  it  "  did  not  suit  her  half  so  well." 

If  women  will  take  or  give  physic,  by  far  the  safest  plan  is  to 
send  for  "the  doctor"  every  time — for  I  have  known  ladies  who 
both  gave  and  took  physic,  who  would  not  take  the  pains  to  learn 
the  names  of  the  commonest  medicines,  and  confounded,  e.  g.y 
colocynth  with  colchicum.  This  is  playing  with  sharp- edged  tools 
"with  a  vengeance." 

There  are  excellent  women  who  will  write  to  London  to  their 
physician  that  there  is  much  sickness  in  their  neighbourhood  in 
the  country,  and  ask  for  some  prescription  from  him,  which  they 
used  to  Uke  themselves,  and  then  give  it  to  all  their  friends  and 
to  all  their  poorer  neighbours  who  will  take  it.  Now,  instead  of 
giving  medicine,  of  which  you  cannot  possibly  know  the  exact 
and  proper  application,  nor  all  its  consequences,  would  it  not  be 
better  if  you  were  to  persuade  and  help  your  poorer  neighbours 
to  remove  the  dung-hill  from  before  the  door,  to  put  in  a  window 
w^hich  opens,  or  an  Arnott's  ventilator,  or  to  cleanse  and  lime- 
wash  the  cottages  ?  Of  these  things  the  benefits  are  sure.  The 
benefits  of  the  inexperienced  administration  of  medicines  are  by 
no  means  so  sure. 

Homoeopathy  has  introduced  one  essential  amelioration  in  the 


132  NOTES    ON   NUESIXG. 

really  experienced  and  observing  nurse  does  not  do ; 
she  neither  physics  herself  nor  others.  And  to  cultivate 
in  things  pertaining  to  health  observation  and  experience 
in  women  who  are  mothers,  governesses  or  nurses,  is  just 
the  way  to  do  away  with  amateur  physicking,  and  if  the 
doctors  did  but  know  it,  to  make  the  nurses  obedient  to 
them, — helps  to  them  instead  of  hindrances.  Such  edu- 
cation in  women  would  indeed  diminish  the  doctor's 
work — ^but  no  one  really  believes  that  doctors  wish  that 
there  should  be  more  illness,  in  order  to  have  more 
work, 
tooio**^^'  (^O  ^^  ^^  often  said  by  women,  that  they  cannot  know 

A\^hat^obser  ^^J^^i^g  ^^  ^^^  ^^^'S  of  health,  or  what  to  do  to  pre- 
vation  alone  gerve  their  children's  health,  because  thev  can    know 

teaches.  ' 

whatmedi-  nothins:  of  "  Patholos^y,"  or  cannot  "dissect," — a  con- 

cine  does.  °  °*'  ^ 

What  nature  fusion  of  idcas  which  it  is  hard  to  attempt  to  disentangle. 

alone  does. 

practice  of  physic  by  amateur  females ;  for  its  rules  are  excellent, 
its  physicking  comparatively  harmless — the  "  globule"  is  the  one 
grain  of  folly  which  appears  to  be  necessary  to  make  any  good 
thing  acceptable.  Let  then  women,  if  they  will  give  medicine, 
give  homoeopathic  medicine.     It  won't  do  any  harm. 

An  almost  universal  error  among  women  is  the  supposition 
that  everybody  must  have  the  bowels  opened  once  in  every 
twenty-four  hours,  or  must  fly  immediately  to  aperients.  The 
reverse  is  the  conclusion  of  experience. 

This  is  a  doctor's  subject,  and  I  will  not  enter  more  into  it ; 
but  will  simply  repeat,  do  not  go  on  taking  or  giving  to  your 
children  your  abominable  "  courses  of  aperients,"  without  calling 
in  the  doctor. 

It  is  very  seldom  indeed,  that  by  choosing  your  diet,  you  can- 
not regulate  your  own  bowels  ;  and  every  woman  may  watch  her- 
self to  know  what  kind  of  diet  will  do  this ;  I  have  known 
deficiency  of  meat  produce  constipation,  quite  as  often  as  de- 
ficiency of  vegetables  ;  baker's  bread  much  oftener  than  either. 
Home  made  brown  bread  will  oftener  cure  it  than  anything  else. 


CONCLUSION.  133 

Pathology  teaclies  the  harm  that  disease  has  done.  But 
it  teaches  nothing  more.  We  know  nothing  of  the  prin- 
ciple of  health,  the  positive  of  which  pathology  is  the 
negative,  except  from  observation  and  experience.  And 
nothing  but  observation  and  experience  will  teach  us  the 
ways  to  maintain  or  to  bring  back  the  state  of  health. 
It  is  often  thought  that  medicine  is  the  curative  process. 
It  is  no  such  thing ;  medicine  is  the  surgery  of  functions, 
as  surgery  proper  is  that  of  limbs  and  organs.  Neither 
can  do  anything  but  remove  obstructions ;  neither  can 
cure ;  nature  alone  cures.  Surgery  removes  the  bullet 
out  of  the  limb,  which  is  an  obstruction  to  cure,  but  na- 
ture heals  the  wound.  So  it  is  with  medicine  ;  the  func- 
tion of  an  organ  becomes  obstructed ;  medicine,  so  far  as 
we  know,  assists  nature  to  remove  the  obstruction,  but 
does  nothing  more.  And  what  nursing  has  to  do  in 
either  case,  is  to  put  the  patient  in  the  best  condition  for 
nature  to  act  upon  him.  Generally,  just  the  contrary  is 
done.  You  think  fresh  air,  and  quiet  and  cleanliness 
extravagant,  perhaps  dangerous,  luxuries,  which  should 
be  given  to  the  patient  only  when  quite  convenient,  and 
medicine  the  sine  qua  norij  the  panacea.  If  I  have  suc- 
ceeded in  any  measure  in  dispelling  this  illusion,  and  in 
showing  what  true  nursing  is,  and  what  it  is  not,  my 
object  will  have  been  answered. 

Kow  for  the  caution  : — 

(3.)  It  seems  a  commonly  received  idea  among  men 
and  even  among  women  themselves  that  it  requires 
nothing  but  a  disappointment  in  love,  the  want  of  an  ob- 
ject, a  general  disgust,  or  incapacity  for  other  things, 
to  turn  a  woman  into  a  good  nurse. 

This  reminds  one  of  the  parish  where  a  stupid  old 


134  NOTES    ON   NUKSING. 

man  was  set  to  be  sclioolmaster  because  he  was  "  past 
keeping  the  pigs." 

Apply  the  above  receipt  for  making  a  good  nurse  to 
making  a  good  servant.  And  the  receipt  will  be  found 
to  fail. 

Yet  popular  novelists  of  recent  days  have  invented 
ladies  disappointed  in  love  or  fresh  out  of  the  drawing- 
room  turning  into  the  war-hospitals  to  find  their  wounded 
lovers,  and  when  found,  forthwith  abandoning  their  sick- 
ward  for  their  lover,  as  might  be  expected.  Yet  in  the 
estimation  of  the  authors,  these  ladies  were  none  the 
worse  for  that,  but  on  the  contrary  were  heroines  of  nurs- 
ing. 

What  cruel  mistakes  are  sometimes  made  by  benevo- 
lent men  and  women  in  matters  of  business  about  which 
they  can  know  nothing  and  think  they  know  a  great 
deal. 

The  everyday  management  of  a  large  ward,  let 
alone  of  a  hospital — the  knowing  what  are  the  laws 
of  life  and  death  for  men,  and  what  the  laws  of  health 
for  wards — (and  wards  are  healthy  or  unhealthy,  mainly 
according  to  the  knowledge  or  ignorance  of  the  nurse) — 
are  not  these  matters  of  sufficient  importance  and  diffi- 
culty to  require  learning  by  experience  and  careful  in- 
quiry, just  as  much  as  any  other  art  ?  They  do  not 
come  by  inspiration  to  the  lady  disappointed  in  love,  nor 
to  the  poor  workhouse  drudge  hard  up  for  a  liveli- 
hood. 

And  terrible  is  the  injury  which  has  followed  to  the 
sick  from  such  wild  notions ! 

In  this  respect  (and  why  is  it  so?),  in  Eoman  Catho- 
lic countries,  both  writers  and  workers  are,  in  theory  at 


CONCLUSION.  135 

least,  far  before  ours.  They  would  never  think  of  such 
a  beginning  for  a  good  working  Superior  or  Sister  of 
Charity.  And  many  a  Superior  has  refused  to  admit  a 
Postulant  who  appeared  to  have  no  better  "vocation"  or 
reasons  for  offering  herself  than  these. 

It  is  true  tve  make  "  no  vows."  But  is  a  "  vow  " 
necessary  to  convince  us  that  the  true  spirit  for  learning 
any  art,  most  especially  an  art  of  charity,  aright,  is  not 
a  disgust  to  everything  or  something  else?  Do  we 
really  place  the  love  of  our  kind  (and  of  nursing,  as  one 
branch  of  it)  so  low  as  this?  What  would  the  Mere 
Angelique  of  Port  Royal,  what  would  our  own  Mrs.  Fry 
have  said  to  this  % 

Note. — I  would  earnestly  ask  my  sisters  to  keep  clear  of  both 
the  jargons  now  current  everywhere  (for  they  are  equally  jargons) ; 
of  the  jargon,  namely,  about  the  "rights"  of  women,  which 
urges  women  to  do  all  that  men  do,  including  the  medical  and 
other  professions,  merely  because  men  do  it,  and  without  regard 
to  whether  this  is  the  best  that  women  can  do ;  and  of  the  jargon 
which  urges  women  to  do  nothing  that  men  do,  merely  because 
they  are  women,  and  should  be  "  recalled  to  a  sense  of  their  duty 
as  women,"  and  because  "  this  is  women's  work,"  and  "  that  is 
men's,"  and  "  these  are  things  which  women  should  not  do," 
which  is  all  assertion,  and  nothing  more.  Surely  woman  should 
bring  the  best  she  has,  whatever  that  is,  to  the  work  of  God's 
world,  without  attending  to  either  of  these  cries.  For  what  are 
they,  both  of  them,  the  one  just  as  much  as  the  other,  but  hsten- 
ing  to  the  "  what  people  will  say,"  to  opinion,  to  the  "  voices 
from  without  ?"  And  as  a  wise  man  has  said,  no  one  has  ever 
done  anything  great  or  useful  by  listening  to  the  voices  from 
without. 

You  do  not  want  the  effect  of  your  good  things  to  be,  "  IIow 
wonderful  for  a  woman .'"  nor  would  you  be  deterred  from  good 
things  by  hearing  it  said,  "  Yes,  but  she  ought  not  to  have  done 
this,  because  it  is  not  suitable  for  a  woman."     But  you  want  to 


136  NOTES   ON  NTESING. 

do  the  thing  that  is  good,  whether  it  is  "  suitable  for  a  woman  " 
or  not. 

It  does  not  make  a  thing  good,  that  it  is  remarkable  that  a 
woman  should  have  been  able  to  do  it.  Neither  does  it  make  a 
thing  bad,  which  would  have  been  good  had  a  man  done  it,  that 
it  has  been  done  by  a  woman. 

Oh,  leave  these  jargons,  and  go  your  way  straight  to  God's 
work,  in  simplicity  and  singleness  of  heart. 


APPENDIX 


138 


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NOTE.  139 


Note  as  to  the  Number  of  "Women  employed  as 
NuKSES  IN  Gkeat  Britain. 

25,466  were  returned,  at  the  census  of  1851,  as  nurses  by- 
profession,  39,139  nurses  in  domestic  service,*  and  2,822  mid- 
wives.  The  numbers  of  different  ages  are  shown  in  table  A, 
and  in  table  B  their  distribution  over  Great  Britain. 

To  increase  the  efficiency  of  this  class,  and  to  make  as 
many  of  them  as  possible  the  disciples  of  the  true  doctrines  of 
health,  would  be  a  great  national  work. 

For  there  the  material  exists,  and  will  be  used  for  nursing, 
whether  the  real  "conclusion  of  the  matter"  be  to  nurse  or 
to  poison  the  sick.  A  man,  who  stands  perhaps  at  the  head 
of  our  medical  profession,  once  said  to  me,  I  send  a  nurse  in- 
to a  private  family  to  nurse  the  sick,  but  I  know  that  it  is  only 
to  do  them  harm. 

Now  a  nurse  means  any  person  in  charge  of  the  personal 
health  of  another.  And,  in  the  preceding  notes,  the  term 
nurse  is  used  indiscriminately  for  amateur  and  professional 
nurses.  For,  besides  nurses  of  the  sick  and  nurses  of  chil- 
dren, the  numbers  of  whom  are  here  given,  there  are  friends 
or  relations  who  take  temporary  charge  of  a  sick  person, 
there  are  mothers  of  families.  It  appears  as  if  these  unpro- 
fessional nurses  were  just  as  much  in  want  of  knowledge  of 
the  laws  of  health  as  professional  ones. 

Then  there  are  the  schoolmistresses  of  all  national  and 
other  schools  throughout  the  kingdom.  How  many  of  chil- 
dren's epidemics  originate  in  these  !  Then  the  proportion  of 
girls  in  these  schools,  who  become  mothers  or  members 
among  the  64,600  nurses  recorded  above,  or  schoolmistresses 
in  their  turn.     If  the  laws  of  health,  as  far  as  regards  fresh 

*  A  curious  fact  will  be  shown  by  Table  A,  viz.,  that  18,122  out  of 
30,139,  or  nearly  one-half  of  all  the  nurses,  in  domestic  service,  are 
between  5  and  20  years  of  age. 


140  NOTE. 

air.  cleanliness,  light,  &c.,  were  taught  to  these,  would  this 
not  prevent  some  children  being  killed,  some  evil  being  per- 
petuated ?  On  women  we  must  depend,  first  and  last,  for 
personal  and  household  hygiene — for  preventing  the  race  from 
degenerating  in  as  far  as  these  things  are  concerned.  Would 
not  the  true  way  of  infusing  the  art  of  preserving  its  own 
health  into  the  human  race  be  to  teach  the  female  part  of  it 
in  schools  and  hospitals,  both  by  practical  teaching  and  by 
simple  experiments,  in  as  far  as  these  illustrate  what  may  be 
called  the  theory  of  it  ? 


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The  House  and  its  Surroundings. 

Premature  Death :  Its  Promotion  and 
Prevention. 

Personal  Appearances  in  Health  and  Dis- 
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The  Heart  and  its  Function. 


The  Nerves. 

The  Ear  and  Hearing. 

The  Head. 

Clothing  and  Dress. 

Water. 

Fatigue  and  Pain. 

The  Throat  and  Voice. 


TO    BE   FOLLOWED    BY: 

Temperature  in  Health  and  Disease. 
Health  of  Travelers. 
Health  in  Schools. 
The  Eye  and  Vision. 
Breath  Organs. 
Foods  and  Feeding. 
And  other  volumes. 


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HEALTH, 


HOW    TO    PROMOTE     IT. 

By  RICHARD   McSHERRY,   M.  D., 

Professor  of  Principles  and  Practice  of  Medicine,  University  of  Maryland ;  Member  ot 
American  Medical  Association;  President  of  L'altimore  Academy  of  Medicine. 


Extract  from  Preface. 

"  Hygiene,  public  and  private,  has  become,  of  late  years,  one  of  the 
most  important  elements  of  modern  civilization.  It  is  a  subject  in  which 
all  mankind  has  an  interest,  even  if  it  be,  as  it  too  often  is,  an  uncon- 
scious interest. 

"  The  present  work  is  addressed  to  the  general  reader,  no  matter 
what  his  pursuit,  and  the  language  is  such  as  any  physician  may  use  in 
conversation  with  an  intelligent  patient  ;  it  is  therefore  as  free  as  such  a 
work  can  be  made  from  scientific  technicalities. 

"  It  is  offered  as  a  contribution  to  a  great  cause,  and  the  writer  trusts 
that  it  will  have  some  influence  in  promoting  the  health,  happiness,  and 
welfare  of  all  who  may  honor  it  with  a  careful  perusal.  The  principles 
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003Sra7E3NrTS- 
PAET  I.— INTRODUCTORY  REMARKS. 
Hygiene  the  Better  Part  of  Medicine.— The  Four  Divisions  of  Human  Life:  The 
First  Quarter,  or  the  First  Score  of  Years.     The  Young  Man ;   the  Young 
Woman.    The  Man  ;  the  Woman.     The  Declining  or  Old  Man. 

PART  JI.-HTGIENICS  IN  SOME  DETAIL. 
Race,  Temperaments,  and  Idiosyncrasies.— Inheritance.— Habit.— Constitution. 
— The  Air  we  Breathe.— Sewers  and  Cesspools.- Ozone. — Malaria.— Animal 
Emanations.  —  Devitalized  Honse-Air.  —  Water.  —  Clothing.  —  Exercise  or 
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cohol.—Use  and  Abuse. — Ardent  Spirits.-Wines.-Malt-Liquors.— Tobacco. 
—Chewing  and  Smoking  should  be  forbidden  in  School.— Report  of  Naval 
Surgeons. 


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D.  APPLETON  &  CO.,  Publisheks,  1,  3,  «&  5  Bond  Street,  New  York 


/ 
V 


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